Day 2 :
Keynote Forum
Cécile Besson Duvanel
Augurix SA, Switzerland
Keynote: The Use of a Specific Oral Contrast Agent for GI Inflammatory Lesions
Time : 09:30-10:10
Biography:
Dr. Cécile Besson Duvanel was awarded a fellowship from the Roche Research Foundation to conduct her MD-PhD thesis in the field of immunochemistry in 2002 at the University of Lausanne, Switzerland. She then completed her MD training at the Pediatric Department of the University Hospital in Lausanne. She has been awarded several international distinctions for her research, including the Milupa Neonatology Award and the Professor Combe Award, and she has authored more than 20 scientific publications in international, peer-reviewed journals. She co-founded Augurix SA in 2007, a start-up active in the development of companion diagnostics in the field of gastroenterology.
Abstract:
Abdominal pain, cramping, bloating, constipation, diarrhoea are all very common clinical symptoms that generate more than 70 million physician visits annually in Europe and over 94 million in the United States. Usually, patients suffering from these symptoms consult at the primary care, where physicians will need to discriminate patients with a benign functional GI disorder, typically irritable bowel syndrome from those suffering from an organic disorder, either with inflammatory etiology, autoimmune etiology (celiac disease), infectious or oncology etiology. Today, good predictors of the severity of digestive disorders and their outcome are still lacking in current medical practice. The state-of-the-art is still based on endoscopic procedures and several publications have demonstrated increasing evidence that endoscopy parameters are better predictors to help identifying patients who should be treated with more aggressive therapies. The most recent advances are in the field of confocal laser endomicroscopy, a technique that allows real time in vivo histology of 1’000-fold magnification during on-going endoscopy. Endomicroscopy requires the application of fluorescent agents either systemically or topically. However, the fluorescent agents currently used are non-specific, thereby limiting the ability to discriminate the different disorders. Therefore, there is a need for diagnostic agents which are non-toxic and which are not hydrolysable or absorbable by the organism. In particular, when the diagnostic agent is to be in contact with a mucous membrane, it is of importance that this agent does not present a non-specific adhesion to the mucous membrane, so that the entire administered dose reaches the target area.
Keynote Forum
Yusuke Saitoh
Asahikawa Medical University, Japan
Keynote: Endoscopic diagnosis and treatment for early colorectal carcinomas- Advancements and challenges
Time : 09:35-10:15
Biography:
Yusuke Saitoh completed his MD and PhD from Asahikawa Medical University, Asahikawa, Japan. He stayed in Texas, USA and did research on flat and depressed type colorectal tumors. He has received many honors and awards. He is a distinguished Director at Asahikawa City Hospital and clinical Professor in Asahikawa Medical University. He is also a manager of the Hokkaido prefecture branch of Japan Gastroenterological Endoscopy and editorial board of Stomach and Intestine (traditional Japanese Journal in regard to gastrointestinal diagnostic and therapeutic endoscopy). He has been invited from 13 countries and performed more than 30 lectures and live demonstrations so far.
Abstract:
Since recent advancement of endoscopic therapeutic technology, the numbers of endoscopic resection for early colorectal carcinomas with little risk of lymph node metastasis is increasing. There have been no reports of lymph node metastasis in intramucosal (Tis) carcinomas, while lymph node metastasis occurs in 6.8–17.8 % of submucosal (T1) carcinomas. Three clinical guidelines have been published in Japan and the strategy of the management for early colorectal tumors is demonstrated. According to 2014 JSCCR Guidelines for the Treatment of Colorectal Cancer, among endoscopically treated carcinomas, T1 carcinoma with a histologically diagnosed as a positive vertical margin should be performed additional surgery. Additional surgery may be considered when at least one of the following histological findings is detected: i) SM invasion depth ＞1,000 μm; ii) histological type of por., sig., or muc.; iii) budding grade 2-3; and iv) positive vascular permeation. While resected lesion is histologically diagnosed as a T1 carcinoma without any histological findings mentioned above, it could be followed up without additional surgery. In order to accomplish complete endoscopic resection with both vertical and horizontal margin negative, ESD is a reliable technique for en block resection regardless of lesions size compared with conventional EMR. It has been discussed about the possibility of the endoscopic total excisional biopsy for T1b carcinomas using NBI or EUS. As for the prognosis of endoscopically resected T1 carcinomas, relapse ratio is relatively low as about 3.4% (44/1,312), but prognosis was poor as 72 of cancer death out of 134 relapsed cases (54%) once relapse has occurred. It is expected that more detailed stratification of lymph node metastasis risk after endoscopic resection for T1 carcinomas and the prognosis of relapsed cases in a prospective fashion will become apparent, and appropriate indication of endoscopic resection including total incision biopsy for T1 carcinomas will be established.
Keynote Forum
Sangeeta Agrawal
Wright State University, USA
Keynote: Medical management of upper GI bleed
Time : 11:15-11:45
Biography:
Sangeeta Agrawal is an Associate Professor of Medicine, Chief of Division of Gastroenterology, and GI Fellowship Program Director at Wright State University. She is also the Section Chief of Gastroenterology at Dayton VA Medical Center. She earned her medical degree from Gandhi Medical College, Osmania University, Hyderabad, India. She completed her Internal Medicine residency and Gastroenterology fellowship at University of Missouri, Columbia, MO. She is a Fellow of American Gastroenterological Association, American Society of Gastrointestinal Endoscopy and American College of Gastroenterology. She serves as Chair of Education Committee of Ohio Gastroenterology Society and as a member of ACG Training Committee. Her research interests include biomarkers for early detection of esophageal adenocarcinoma, role of gut microbiota in gastrointestinal diseases, and Barrett’s esophagus. She has mentored several GI fellows, medical residents and medical students. She is also co-founder and member of advisory committee of a non-profit organization, Global Pragathi.
Abstract:
Upper Gastrointestinal Bleeding is a medical emergency that requires prompt medical and endoscopic management. It accounts for 7-8% of acute medical admissions costing about $2 billion annually in USA. The mortality remains around 3.5-10% despite medical and surgical advances. Recent reports have indicated a decrease in mortality rates both in USA and Europe. The objective of my talk is to discuss optimal management guidelines for management of patients with acute upper gastrointestinal bleeding and to identify high risk patients. I will also discuss the common causes of upper gastrointestinal bleeding and the role of endoscopy in the management of acute upper gastrointestinal bleeding.
Keynote Forum
Ehab Abdelatty
Menoufia University, Egypt
Keynote: New era of hemostasis (Hemospray: A magic powder)
Time : 10:10-10:50
Biography:
Ehab Abd-El-Atty has completed his PhD from Faculty of Medicine, Menoufia University, Egypt and Master degree of Medical Sciences from Faculty of Medicine, Catholic University, Leuven, Belgium. He is Professor of Internal Medicine, Hepatology and Gastroenterology, Faculty of Medicine, Menoufia University, Egypt. He has published more than 30 papers in reputed journals and has been serving as a reviewer of Menoufia Medical Journal (MMJ). He is a member of AASLD (American Association for the Study of the Liver Diseases), ESGE (European Society of Gastrointestinal Endoscopy) and EASL (European Association for the Study of the Liver).
Abstract:
Gastrointestinal (GI) bleeding is a common clinical problem and one of the most important emergencies in gastroenterology. UGIT bleeding may be due to general causes (Coagulation defects or Bleeding disorders) or local causes (Esophageal, Gastric lesions or duodenal lesions). Mortality rate is still high about 5%–10% in patients with peptic ulcer bleeding and about 15% in those with variceal hemorrhage. 5-10% of patients will not be initially controlled by endoscopic intervention or they will experience a recurrence of bleeding in the first 24 to 72 hours. Hemospray (TC-325) is a novel hemostatic agent for the treatment of uncontrolled gastrointestinal bleeding (Variceal hemorrhage, Peptic ulcer, colonic ulcer, bleeding malignant tumors). It is a hemostatic spray propelled by carbon dioxide under pressure, which can achieve rapid hemostasis 92-100% of the cases. The powder forms a barrier over the vessel wall, quickly stopping the bleeding and increases the local concentration and activating platelets and of clotting factors and enhances thrombus formation. It is not absorbed or metabolized by mucosal tissue (no risk of systemic toxicity). Hemostatic spray is safe, quick, simple and easy. It does not require very precise targeting such as deployment of hemoclips. It covers a large surface area as bleeding malignant tumors. The effects of the spray disappear within 24 h to 72 hour. It stops uncontrolled GIT bleeding in 93-100% of cases. Hemospray appears to allow safe control of acute bleeding and may be used in high-risk cases as a temporary measure or a bridge toward more definitive therapy.
Keynote Forum
Mohamed Abeid
Cairo University School of Medicine, Egypt
Keynote: Endoscopic management of obesity
Time : 12:15-12:45
Biography:
Mohamed A Abeid has completed his MD/PhD degree from Cairo University School of Medicine and did his Postdoctoral endoscopy fellowship hands on training at the UCL, London, UK. He is a consultant gastroenterologist Cairo university school of medicine; training young doctors (Egyptians & non-Egyptians from Sudan, Yemen, Kuwait, Syria, Iraq, Libya, Tunisia, etc.) at the Endoscopy Unit Cairo University. He is a member of the European & American society of Gastrointestinal Endoscopy (ESGE, ASGE). He has published two cases in the GIE journal (ASGE) & BMJ case reports. He has been the Educational councilor of the Egyptian Society for the Study of Endoscopy and Hepatogastroenterology (ESEHG) responsible for medical updates (2009-2013).
Abstract:
Endoscopically placed intragastric balloons (IGBs) for the treatment of obesity were first introduced to the U.S. market in 1985 with the Garren-Edwards Gastric Bubble (GEGB). The GEGB was associated with multiple adverse events including gastric mucosal damage and small-bowel obstruction related to spontaneous balloon deflation with migration into the small bowel. This necessitated endoscopic or, more commonly, surgical retrieval of the migrated balloons. In addition, the GEGB failed to demonstrate efficacy in a prospective, double-blind, sham-controlled, randomized trial of 59 obese patients with a 9-month follow-up period. These issues resulted in its withdrawal from the U.S. market. In the early 1990s, the BioEnterics Intragastric Balloon (BIB) (Allergan, Irvine, Calif), currently known as the Orbera Intragastric Balloon (Apollo Endosurgery, Austin, Tex), was developed. The Orbera is an elastic spherical balloon made of silicone, filled with 450 to 700 mL of saline solution. The deflated balloon comes preloaded on a catheter, which is blindly advanced transorally into the stomach. An endoscope is then advanced alongside it to ensure accurate placement of the balloon in the fundus. Under direct visualization, the balloon is then inflated by injecting saline solution mixed with methylene blue through the external portion of the catheter. If inadvertent balloon rupture occurs, the methylene blue is systemically absorbed, causing a change in urine color, which serves as an alert that the balloon has deflated. The Orbera balloon is currently used in many countries outside the United States and is typically implanted for 6 months and then retrieved endoscopically. Newer IGBs with different migration-hindering and deployment/retrieval mechanisms and some that allow for endoscopic balloon volume adjustments are now available.
Keynote Forum
Ernest Jehangir
North Cumbria University Hospitals, UK
Keynote: Colonic stenting for Malignant intestinal obstruction is a safe and effective method for bridging to surgery and palliation
Time : 12:45-13:15
Biography:
Ernest Jehangir had completed his undergraduate medicine at the Christian Medical College Vellore India and post graduate surgical training in Newcastle, UK. He is a colorectal surgeon and served as the surgical tutor and clinical tutor. \\\\r\\\\n
Abstract:
Colonic stenting using a TTS delivery system is a safe and effective means of treatment for intestinal obstruction caused by adenocarcinoma in the acute or urgent setting. It can be used as a bridge to surgery effectively converting an emergency open operation to an urgent laparoscopic resection. It is very effective in treating colonic obstructions in the palliative setting. This 12 year experience of nearly 100 cases show that it can be achieved in a District General Hospital and one of the highest series in the UK.
Keynote Forum
Nikos Viazis
Evangelismos Hospital, Greece
Keynote: Small bowel capsule endoscopy for the investigation of obscure gastrointestinal bleeding: When we should do it and what should we expect
Time : 13:35-14:05
Biography:
Dr. Nikos Viazis is a consultant gastroenterogist working at Evangelismos Hospital, Athens, Greece. He wrote as a first author or as a co-author about 45 peer reviewed articles, which have 712 citations. He attended many Greek and International conferences. In most of them he participated actively by giving lectures or presenting abstracts. His main interests of research include Inflammatory Bowel Disease, capsule endoscopy and motility – pH studies of the esophagus. He also peer reviewed several articles for international journals and participated in numerous multicenter trials organized by pharmaceutical companies as an investigator.
Abstract:
Obscure gastrointestinal bleeding is defined as bleeding of unknown origin that persists or recurs (i.e. recurrent or persistent iron deficiency anemia, fecal occult blood test positivity or visible bleeding) after a negative initial workout that necessarily includes gastroscopy and colonoscopy. In clinical practice, small bowel capsule endoscopy is recommended as a third stage examination in these patients, since it is a simple, safe, non-invasive and reliable test. To date there are three available small bowel capsule systems that have gained FDA approval and their diagnostic yield has shown to be superior to other diagnostic modalities for the investigation of the small bowel in patients with obscure gastrointestinal bleeding. The test should be performed as close to the bleeding episode as possible and the administration of a purgative bowel preparation before the administration of capsule endoscopy is recommended by the European Society of Gastrointestinal Endoscopy (ESGE). Issues that still remain to be solved are the definition of bleeding lesions and what really represents a positive finding, as well as the question of whether the outcome of patients with obscure gastrointestinal bleeding is altered after the test, i.e. to better define subgroups of patients that will mostly benefit from capsule endoscopy. In the future small bowel capsule endoscopy might be able to get magnetically guided, while tissue samples might be available as well.
Keynote Forum
Inta Kalnina
Daugavpils University, Latvia
Keynote: Fluorescent studies of Human blood plasma albumin alterations in colorectal cancer patients
Time : 14:05-14:35
Biography:
Dr. Kalnina Inta Eduards, biochemist was born in Liepaja, Latvia. She graduated from Latvia State University in 1972. She worked as a researcher in Moscow Medical Institute, Moscow, Russia from 1972-82 and in Latvian Medical Academy from 1982-1993. She is a leading researcher at Daugavpils University, Latvia from 2007 to till date. Her research interests include fluorescemce based metods for development of structural and functionalof membranes and plasma in different pathologies, immune state of patients. She is a board member of J. India Research. She has Publications of approximately 220 and participated in 110 Conferences and Congresses.
Abstract:
The novel fluorescent probe ABM (derivative of benzanthrone) was used to characterize blood plasma albumin from colorectal cancer patients in context of the hosts immunological parameters and state of cancer progression. For study patients with colorectal cancer were examined: 10 day before and 10 days after their surgical treatment ; 2) as disease worsened (StagesIIa, IIIb, IV); 3) advanced cancer patients. The aim of studies was to evaluate the potentialutility of measures of ABM fluorescence parameters as a standart tool in the analysis of host immune status and for a clinical interpretation of alterations in albumin per se and lymphocytes functional activity in patients. ABM binds with blood plasma albumin with high level of selectivity. Probe ABM is very sensitive to all known conformational changes of albuminin the region pH 3-12. Spectral parameters of ABM binding with plasma albumin reflects albumin \\\\\\\"effective\\\\\\\" concentration (equivalent of \\\\\\\"healthy\\\\\\\" albumin in patients plasma), alterations of albumin globule, its physical and functional properties, characteristics of binding sites properties. A result clarifies a heterogenous nature of ABM binding and revealed different conformation of albumiņ in each observed group of patient. The results showed strong correlation with select immunological parameters (CD4+, CD8+, ratio CD4+/CD8+, CD38+, CD16+, level of immunoglobulines IgA, IgG, IgM etc.). Decrease in the CD4+/CD8+ ratio mainly depend on an increase in the T- suppress or cells in patients without metastases, whereas it is due to a decrease in the T-helper cell in most patients with metastatic disease. Surgical treatment affects immunological parameters and apperead to elevate lymphocytes functional activity. The preoperative immune state of patients is important for their survival. Immunosupression increased gradually with progress of cancer; capacity of albumin binding reserve and effective†concentration decrease. These findings suggest likely physical (structural) and functional alterations in the patients plasma were a function of cancer stage. In advanced cancer, in contrast to other groups, the absolute number of lymphocytes had direct (not inverse) correlation with ABM fluorescence intensity. The higher level of lymphocytes number, T-cell proliferative activity, and albumin ‘effective’ concentration have a beneficial effect on overall survival. There was excellent agreement between changes in spectral characteristics and both clinical and pathological estimates of disease severity. Measures of ABM fluorescence intensity values in blood plasma might be a useful tool in the evoluation of the immune status of patients in clinics including prognosis, prediction of therapeutic efficacy, treatment outcomes. The fluorescence-based method is less expensive, not very time-consuming, technically simple, 100 times more sensitive than standard ones.
Keynote Forum
Tomaz Jagric
Maribor Medical School, Slovenia
Keynote: The flow cytometric study of immune modulation in the Sentinel lymph nodes of Gastric cancer patients
Time : 14:35-15:05
Biography:
Tomaz Jagric completed his MD and PhD from medicine and general surgery in Slovenia and Postdoctoral studies from Ljubljana Medical School. His main field of expertise is the upper gastrointestinal, hepatico-pancreato-billiary and laparoscopic gastric cancer surgery. He has been habilitated as assistant researcher on Maribor Medical School in Slovenia, and has since been working as the head researcher on many projects. Currently he is leading two projects “Flow cytometric detection of micrometastases in the sentinel lymph nodes of gastric cancer patients†and “Detection of Free tumor cells in abdominal lavage fluids of patients with advanced gastric cancer as a selection marker for hyperthermic intraoperative intraperitoneal chemotherapyâ€. He is also conducting several trails of negative pressure therapy in abdominal compartment syndrome as well as palliative rectal cancer stenting and stenting of malignant obstructions in gastric cancer patients.
Abstract:
Background: We introduced a novel method of intraoperative downstream LN metastases prediction with focused sentinel lymph node flow cytometry analysis. With this method we could detect SLN metastases as well as alterations in local immune response indigenous to metastatic involved SNLs. These alterations allowed an even more precise detection of downstream LN metastases.\\\\\\\\r\\\\\\\\n\\\\\\\\r\\\\\\\\nAim: The aim of our study was to determine whether accumulation of CD25high CD127low expressing activated regulatory T lymphocytes in SNLs could predict downstream lymph node metastases.\\\\\\\\r\\\\\\\\n\\\\\\\\r\\\\\\\\nMethods: Thirteen patients with histologically verified adenocarcinoma of the stomach were included in our study. Intraoperative subserosal Patente Blue V dye injection was used for LN navigation. The first blue lymph node was extracted for intraoperative analysis. The SNL was halved, with one half for frozen section and the other half for flow cytometry analysis. The flow cytometry was used to detect CEACAM and EpCAM expressing tumor cells and CD25high CD127low expressing cells.\\\\\\\\r\\\\\\\\n \\\\\\\\r\\\\\\\\nResults: From thirteen included patients, sixwere node positive on final histology. With the frozen section analysis only three from six node positive patients could be determined during the operation. Similarly, CEACAM/EpCAM expressing cells could be found in three from six node positive patients with flow cytometry. However, in all six node positive patients the SLNs contained lymphocytes in the CD25high CD127low region representing activated regulatory T lymphocytes. From 7 node negative patients only one patient had SNL containing CD25high CD127low expressing cells. The ROC analysis determined presence of CD25high CD127low cells in SNLs as a significant predictor for downstream LN metastases (AUC 1; p = 0.002). \\\\\\\\r\\\\\\\\nConclusion: The detection of CD25high CD127low expressing cells in SNL is an accurate predictor of downstream LN metastases.\\\\\\\\r\\\\\\\\n
Keynote Forum
Skerdi Prifti
Medical University of Tirana, Albania
Keynote: Helicobacter pylori, peptic ulcer, and gastric cancer in Albanian population
Time : 15:05-15:35
Biography:
Skerdi Prifti completed MD in 1986 and PhD from the Faculty of Medicine, University of Tirana, on 1995. He received two Fulbright Scholarships on 1995 and 2001 at Georgetown University, Washington DC for diagnostic and therapeutic endoscopy. He has been involved in several international collaboration studies on Helicobacter pylori with Herlev Hospital, Copenhagen, University of Bordeaux, France and Naval Institute, Bethesda, Maryland. He was the President of the Albanian Association of Gastrohepatology during 2009-2011. He is the Professor of Medicine since 2011 at the Medical University of Tirana and Chief of Endoscopy Unit at Gastrohepatology Department, University Hospital Mother Theresa, Tirana, Albania. He is the author and co-author of one American and several Albanian textbooks chapters.
Abstract:
Helicobacter pylori (Hp) are considered the main factor of ulcer genesis and a primary carcinogen for gastric cancer. The overall presence of this bacterium reflects the social-economic and hygienic condition of a certain population. The prevalence of Hp is higher in developing countries, but the range of infection still differs among them. Prevalence of Hp in Albanian population, based on data of the beginning of the ’90-es is between the highest in Europe (90-100%), demonstrated on studies on adult and children population. Higher frequency of Hp infection has been seen compared with Western populations (Denmark). There was also demonstrated that the Albanian strains of Hp are more aggressive compared to the strains of Western patients (USA). Therefore the Albanian population has suffered of a high incidence and prevalence of Peptic Ulcer through the last decades, associated with a high number of admissions and surgical complications. By the other side, based on hospital admissions, endoscopies performed, and national data (WHO), Albanian population has one of the highest incidence, prevalence and death rate from gastric cancer in Europe. After twenty years of political transition, change of economic system, and social-economic improvement, there seem to be a tendency of decrease of Hp infection in our country (=/<70%). In the same time, there is a decline of Peptic Ulcer frequency, hospital admissions and number of operations, while incidence and prevalence of Gastric Cancer remains high, with many cases affecting young adults. We may speculate that the decline of the incidence of peptic ulcer but not of the gastric cancer on the Albanian population reflects the natural history of gastro-duodenal diseases due to the Hp infection.
Keynote Forum
Marcela Hermoso R
University of Chile, Chile
Keynote: The role of the novel IL33/ST2 system in the causation of ulcerative colitis
Time : 16:50-17:15
Biography:
Marcela A Hermoso is a Professor of Immunology at the Disciplinary Program of Immunology of the Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago, Chile. Her research focuses on the pathogenesis of intestinal inflammation and how altered immune responses can promote the ensuing diseases.
Abstract:
ST2/IL33 signaling pathway has been related to many inflammatory disorders as well as inflammatory bowel disease (IBD). IL-33, an IL-1 family member, is expressed in many cell types and its nuclear localization regulates gene transcription. IL-33 is released upon necrosis and the precursor form is enzymatically processed to promote an inflammatory response as a damage-associated molecular pattern or alarmin. The IL-33 receptor ST2, encoded by IL1RL1, is expressed as both a membrane-anchored receptor (ST2L) activated by IL-33 and as a soluble variant (sST2) that exhibits increased anti-inflammatory properties in inflammatory conditions and has been proposed as a prognostic disease biomarker. We characterized the IL33/ST2 system in mucosa from IBD patients and the effect of clinical course and therapy on sST2 content and cellular distribution as predictive markers of response to treatment, disease activity and outcome. These are the first findings demonstrating molecular and cellular mechanisms on the regulation of ST2 system in mucosa inflammation. This conference will offer cutting edge biomedical data on recent advances in the role of ST2 in these diseases.