Day 1 :
Keynote Forum
Nathalie Rivard
Universite de Sherbrooke, Sherbrooke, Canada
Keynote: Epithelial SHP-2 protects the intestinal mucosa against colitis and colorectal cancer
Time : 08:20-09:00
Biography:
Nathalie Rivard received her PhD from Université de Sherbrooke in 1994 and completed a 3.5 year Post-doctorate at the Centre de Biochimie-CNRS, Université de Nice, France with Dr. J Pouysségur in 1997. Then, she accepted a faculty position in the Department of Anatomy and Cell Biology at the Faculté de Médecine et des Sciences de la santé de l’Université de Sherbrooke. Since 2008, she is the Chair of the Department of Anatomy and Cell Biology and Chair of the Cancer Axis at Université de Sherbrooke. Her research focuses on the analysis of signaling pathways that control proliferation, differentiation, tumorigenesis and inflammatory response of intestinal epithelial cells. She has published more than 80 papers in reputed journals. She is the recipient of 2013 Canadian Association of Gastroenterology Research Excellence Award and holds a Canada Research Chair.
Abstract:
SHP-2 is a Src homology 2 containing protein tyrosine phosphatase (PTP) expressed in most embryonic and adult tissues. SHP-2 regulates many cellular functions including growth, differentiation, innate immune response, chemotaxis and survival. Genetic and biochemical evidence demonstrate that SHP-2 can regulate major signalling pathways including the RAS/MAPK, PI3K/Akt and JAK/STAT pathways. Interestingly, variations within the human gene locus encoding SHP-2 have been associated with increased susceptibility to develop ulcerative colitis. We thus, analyzed the role of SHP-2 in the intestine by first generating mice with an intestinal epithelial cell (IEC)-specific deletion of SHP-2 expression (SHP-2IEC-KO mice). Interestingly, these mice rapidly developed inflammation one month after birth, with clinical and histopathological features similar to ulcerative colitis. Alterations in Goblet/Paneth cell ratio were observed two weeks after birth, before the onset of inflammation and were associated with significant alterations in microbiota composition. With age, SHP-2IEC-KO mice developed colitis-associated adenocarcinomas. To further analyze the protective role of SHP-2 in the intestinal epithelium, we also generated mice expressing a constitutive active form of SHP-2 specifically in IECs (SHP-2IEC-E76K mice). These mice were either challenged with dextran sulfate sodium (DSS) to induce chemical colitis or with Citrobacter rodentium to induce infectious colitis. Results showed that SHP-2IEC-E76K mice were resistant to DSS treatment or C. rodentium infection. Thus, SHP-2 activation exerts protective actions against mucosal damage and during infection with an A/E (attaching and effacing) bacterial pathogen. Finally, we found reduced SHP-2 expression in intestinal biopsies from patients with active colitis, emphasizing the inverse relationship between SHP-2 expression and colonic inflammatory phenotype. Overall, our results indicate that SHP-2 maintains barrier function in the colon and thereby, helps to prevent spontaneous microbiota-driven inflammation and colitis-associated cancer development.
Keynote Forum
Moh’d Amin El-Gohary
The International Bariatric Club, United Kingdom
Keynote: Gohary’s disease
Time : 9:15-10:00
Biography:
Amin El-Gohary completed his MBBCh in 1972 and his Diploma in General Surgery in 1975 at Cairo University, Egypt. He became a Fellow of The Royal College of Surgeons in UK: Edinburgh in 1979, London in 1980 and Glasgow in 1997. He worked initially in Egypt, then moved to Kuwait, then to UK, before coming to UAE in 1983. In the same year, he became the Chief and Head of the Department of Pediatric Surgery of a large government hospital. Additionally, he held post as a Medical Director for the same hospital starting 1989. He was appointed as Chief Disaster Officer during Gulf War in 1991. He also held post as the Clinical Dean of Gulf Medical College, Ajman for 3 years. He is well known in Abu Dhabi for his extensive interest and involvement in scientific activities. He is the President of the Pediatric Surgical Association of UAE. He was awarded the Shield of the College of Pakistan in 1996 and the Medal of International Recognition in pediatric urology from the Russian Association of Andrology in 2010. He was given a Silver Medal from the Royal College of Surgeons, Ireland in 1978 and an Honorary Fellowship from the Royal College of Surgeons, Glasgow in 1997. In 2001, he became a Visiting Professor at Munster University, Germany. He is member of several associations in pediatric surgery: Executive Member of the International Society of Intersex and Hypospadias Disorder (ISHID), British Association of Pediatric Surgery, Egyptian Association of Pediatric Surgeons, Asian Association of Pediatric Surgeons and Pan African Association of Pediatric Surgery. He is also the Founder and Member of The Arab Association of Pediatric Surgeons. He has an intensive academic and teaching experience, has written several publications in distinguished medical journals, and has made several poster and paper presentations in national and international conferences. Currently, he is an External Examiner for the Royal College of Surgeons.
Abstract:
Gohary’s disease is a new phenomenon that has not been described before. It depicts a group of children, who present to emergency department, with severe agonizing abdominal pain. The pain tends to start and ends abruptly, without predisposing factor and recurs after minutes or hours. Ultrasonography revealed a mesas at right iliac fossa, which is usually diagnosed as intussusception. The underlying cause of such phenomenon is the fecal impaction of stool at terminal ileum which act as intermittent intestinal obstruction. We have encountered 19 cases over the last 5 years, their age varied from 9 months to 8 years with the majority under the age of 2 years. The cadinal symptoms and signs include severe abdominal pain that warrants urgent attention, empty rectum on examination and ultrasound diagnosis of intussusception. All of these cases were managed by fleet enemas with immediate response. Awareness of this condition will help to avoid unnecessary investigation and unjustified exploration.
- Gastrointestinal Carcinogenesis and Therapeutics | Inflammatory Bowel Disease Research vs Treatment / Management | Gastrointestinal Bleeding- Treatment and Management
Location: Meriden-Suite
Chair
Nathalie Rivard
Universite de Sherbrooke, Canada
Co-Chair
Pawan Mathur
Royal Free London NHS Fundation Trust, UK
Session Introduction
Harshadkumar Rajgor
University of Birmingham, UK
Title: Why is the recurrence rate of residual or recurrent disease following endoscopic mucosal resection (EMR) of the oesophageal dysplasia’s and T1 tumours higher in the Midlands cancer network?
Time : 09:40:10:00
Biography:
Harshadkumar Rajgor has completed his MBChB from The University of Birmingham Medical school, UK. He is currently a Core Surgical Trainee in prestigious East Midlands Deanery. He did many presentations at national and international level. He is actively involved in teaching of medical students.
Abstract:
Background: Barrett’s oesophagus increases the risk of developing oesophageal adenocarcinoma. Over the last 40 years there has been a 6 fold increase in the incidence of oesophageal adenocarcinoma in the western world and the incidence rates are increasing at a greater rate than cancers of the colon, breast and lung. Endoscopic mucosal resection (EMR) is a relatively new technique being used by 2 centres in the Greater Midlands cancer network. EMR can be used for curative or staging purposes, for high grade dysplasias and T1 tumours of the oesophagus. EMR is also suitable for those who are deemed high risk for oesophagectomy. EMR has a recurrence rate of 21% according to the Wiesbaden data.
Method: A retrospective study of prospectively collected data was carried out involving 24 patients who had EMR for curative or staging purposes. Complications of residual or recurrent disease following EMR that required further treatment were investigated.
Results: In 54% of cases residual or recurrent disease was suspected. 96% of patients were given clear and concise information regarding their diagnosis of high grade dysplasia or T1 tumours. All 24 patients consulted the same specialist healthcare team.
Conclusion: EMR is a safe and effective treatment for patients who have high grade dysplasia and T1NO tumours. In 54% of cases residual or recurrent disease was suspected. Initially only single resections were undertaken. Multiple resections are now being carried out to reduce the risk of recurrence. Complications from EMR remain low in this series and consisted of a single episode of post procedural bleeding. It is vitally important to carry out adequate resections to reduce recurrence rates.
Ulrike Stein
Charité Universitätsmedizin Berlin, Germany
Title: Novel key players in cancer metastasis and signaling-based inventions for metastasis restriction
Biography:
Ulrike Stein has completed his PhD from the Humboldt University Berlin, Post-doctoral studies from the National Cancer Institute/NIH Frederick MD, her habilitation from the Charité Universitätsmedizin Berlin and was 2009 appointed as Professor. She heads the research group of Translational Oncology of Solid Tumors at the Experimental and Clinical Research Center, Charité and Max-Delbrück-Center for Molecular Medicine in Berlin. She has published more than 130 papers in reputed journals, reveiced national and international scientific awards, is contributing to scientific consortia, is serving as Editorial Board Member of several journals, and acts as reviewer for journals and funding organizations.
Abstract:
Metastatic dissemination of primary tumors is directly linked to patient survival in many tumor entities and critically limits successful therapy. In human colorectal cancer (CRC), we identified the novel gene Metastasis Associated in Colon Cancer 1, MACC1. MACC1 regulates fundamental processes like proliferation, motility, and dissemination in cell culture and metastasis in mouse models. MACC1 regulates the transcription of genes able to induce metastasis by themselves; e.g., it was identified as a master regulator of c-Met. In CRC patient tumors and blood, MACC1 is a tumor stage-independent predictor for metastasis and survival, allowing early identification of high-risk patients. MACC1 is confirmed as prognostic and predictive biomarker and decisive driver for tumorigenesis and metastasis in a broad variety of solid cancers, correlating to patient survival. MACC1 inhibitors are not available so far. Thus, we developed MACC1-signaling based interventions for metastasis restriction. First, we identified the gene promoter of MACC1, unveiled its transcriptional regulation, and employed the MACC1 promoter for high throughput screenings. We identified the first transcriptional small molecule MACC1 inhibitors. These drugs restrict MACC1-induced metastasis in mice. Furthermore, we addressed the impact of MACC1 post-translational modifications for developing intervention strategies. Using mass spectrometry, we identified kinases phosphorylating MACC1. Targeting the kinase for MACC1 tyrosine phosphorylation with inhibitors employed in clinical trials restricts MACC1-induced tumor growth and metastasis in mice. In summary, transcriptional and post-translational regulations of MACC1 are druggable by small molecules inhibitors. We present first MACC1-signaling based interventions for restriction of tumor progression and metastasis of CRC.
Lynnette R. Ferguson
The University of Auckland, New Zealand
Title: Dietary fibre- How inflammatory bowel disease patients should be advised in relation to dietary fibre intake?
Biography:
Lynnette R Ferguson completed her DPhil (Oxon.) at The University of Oxford, UK, then returned to a Post-doctoral position at The University of Auckland, where she had done her undergraduate degrees. She successfully competed several grants before being offered a tenured position with the Auckland Cancer Society Research Centre at The University of Auckland. In 1990, she was selected to establish a new Discipline of Nutrition at the University, where she retains a half time position alongside her Research Centre appointment. She has successfully supervised more than 50 Post-graduate students for thesis completion.
Abstract:
The problems faced by Inflammatory bowel disease patients in eating a normal balanced diet are well recognised. There appears to be confusion about whether or not these patients should regulate their dietary fibre intake. While randomised controlled intervention studies have been done with a number of dietary fibre sources, no clear pattern has emerged. Part of the problem may be that many intervention studies used dietary fibre supplements that were not pure in composition. In it’s original definition, dietary fibre consisted only of plant cell walls, and these still comprise a major part of this group. Many of the dietary fibre supplements tested in IBD patients contained mixtures of different types of plant cell walls which might be expected to have contrasting effects, as well as containing other components now included in the definition of dietary fibre. Additionally, there was often variability in the disease states of individuals recruited into the study. Not considered in these older assessments, however, is the possibility that there were genotype specific effects. Over a number of years, we have recruited a cohort of IBD patients, and asked about their self-assessed dietary tolerances and intolerances. This work has then been assessed in relation to genotype. In a number of cases, we have been able to identify specific effects, either benefical or adverse, associated with specific genetic variants. Of particular interest is the strong benefit shown by consumption of jerusalem artichoke by individuals carrying a variant in the forkhead box O3 (FOX03) gene. This food item is an excellent source of the dietary fibre, inulin, which is known to have prebiotic affects, affecting the composition of the colon microbiome. It also became apparent that a number of IBD patients avoided whole grain foods, such as barley, rye and wheat, especially wheat bran. These negative associations showed a link with genetic variants in the human leukocyte antigen (HLA) region in some cases. However, it was also clear that a number of individuals who avoided such foods did not carry a variant genotype, and often that their avoidance was based on advice from others, rather than direct experience. This is unfortunate advice, since there is good evidence to suggest that such dietary fibre sources can protect against colorectal cancer. Given the high prevalence of this type of cancer in IBD patients, increasing rather than decreasing this group of foods may have long term benefits that might not be apparent in the short term.
Muhammad S Niam
Brawijaya University School of Medicine, Indonesia
Title: The Rule of Eicosapentaenoic Acid and Docosahexaenoic Acid on Nutritional Status, CRP, 15-Hete in Cachextic Unresectable Colorectal Cancer Patients
Time : 11:00-11:20
Biography:
Edwin Cristian Rivas graduated as Doctor of the Universidad Mayor de San Andrés. He made his specialty in the Central Military Hospital No. 1 "Dr. Rafael Orihuela "La Paz - Bolivia. He is currently Director of Clinical Specialities Kolping El Alto - Bolivia, is also Founder and Editor in Chief of the Medical Journal Scientific Father Adolph Kolping, published since 2012. He is the Founder of the Center for Training Laparoscopy (CELAP) created in 2014 in order to provide training to surgeons, gynecologists, urologists and other surgical specialties that require training in minimal access surgery in Bolivia and other countries. He has published some work in local biomedical journals.
Abstract:
Background: Incidence of colorectal cancer is increasing, most of the patients in Indonesia are found in advanced stages and often accompanied by complications, such as cachexia. Cachexia increases morbidity and mortality, so it requires good nutritional management. EPA as the anti-cachexia agent is promising, but still needs further study.
Objectives: To find out decrease of PG-SGA scores, increase of hemoglobin and albumin levels and decrease of CRP and 15-HETE levels in advanced CRC patients who received EPA and DHA, compared with control group.
Methods: Total of 40 advanced CRC patients with weight loss >5% in the last 3 months were divided into 2 groups. The treatment group got EPA and DHA capsules for a total dose 2g/day of EPA, while the control group got plasebo. At the baseline, skor PG-SGA, hemoglobin, albumin, CRP and 15-HETE were examined. Then, we evaluated PG-SGA scores every 2 weeks, hemoglobin, albumin and CRP every 4 weeks and 15-HETE levels by the end of the study. Then we used T-test and repeated Annova to compare the two groups.
Results: In the treatment group, PG-SGA scores were decreased, the level of albumin was increased, the levels of CRP and 15-HETE were decreased and were significantly different from the control group. Hb levels were not significantly different in the two groups.
Conclusions: The use of EPA and DHA can improve the nutritional status, lower levels of CRP and 15-HETE in cachextic advanced CRC patients.
Mitsunori Yasuda
Kyoto Prefectural University of Medicine, Japan
Title: Strategies for safe and precise ESD
Time : 11:20-11:40
Biography:
Mitsunori Yasuda has completed his MD from Kyoto Prefectural University of Medicine and completed his PhD from the same University. He is the Director of Department of Gastroenterology and Hepatology and the Director of Endoscopy Center of Uji Tokushukai Hospital, Kyoto, Japan, and has been working as the Professor of Department of Clinical Gastroenterology of Kyoto Prefectural University of Medicine since 2007.
Abstract:
ESD, now spreading globally as therapeutic endoscopy for early malignant esophageal, stomach, and large intestinal tumors, can excise larger lesions, less invasively, than conventional EMR and surgery. However, since ESD technical difficulties are relatively high as compared to EMR, appropriate knowledge and skills for ESD must be acquired. Today, I introduce and present tips and tricks for completing safe and precise ESD. First, selection of appropriate cases based on accurate diagnosis is required, using Image Enhanced Endoscopy such as NBI magnification or chromoendoscopy. It is necessary to correctly determine the width and depth of lesions and thereby ascertain correct indications for ESD. Then, to safely perform procedures, suitable endoscopes, attachments, and devices must be selected, as well as setting up high frequency electric generators. Moreover, to uniformly excise the submucosa to a suitable layer, it is important to maintain good visual fields and proper orientation operatively, making local injection of adequate solution, water jet function and suitable hemostatic procedures essential. Since acquiring good operative views reduces complications, such as bleeding and perforation, and shortens operative time, combining suitable traction methods is very useful. The clip and thread method and the clip and snare method (the later one devised by the author) are both quite useful. Using these methods and devices properly, and combining them, and avoiding damage to muscle layers are important for successful ESD. I will present various tips and tricks for completing safe and more stable ESD with actual cases.
Errawan R Wiradisuria
Indonesian Society of Endo-Laparoscopic Surgeons , Indonesia
Title: Laparoscopic Distal Pancreatectomy for Insulinoma
Time : 11:40-12:00
Biography:
Errawan R Wiradisuria is the President of Indonesian Society of Endo-Laparoscopic Surgeons and Chairman of Advance Laparascopic Surgery Courses (Asia-Pacific). He has published numerous papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Insulinomas are benign neuroendocrine tumors which are the most common of the pancreatic islet cell tumors, yet it remains a rare case. The incidence are 1-4 cases in one million patients a year. 60% are woman with a median age at presentation of 47 years. 90% are solitary and 10% multiple. More than 90% are benign adenomas and about 5%-6% of cases are malignant, and 5%-8% are associated with multiple endocrine neoplasm (MEN type I). Most insulinoma are 1-3 cm in size. Hyperinsulinism causes severe hypoglycemia and leads convulsion, depression and coma. Initial operation is curative in 88%, and long-term survival is normal. Recurrence rates of 7% (sporadic) and 21% (MEN type I) have been reported in 20 years. Clinical manifestations are related with endogenous hyperinsulinism: Autonomic (less specific) like sweat, worried, tremble, nausea, hungry palpitation and tingling. The more specific neuroglycopenic are confusion, change in behavior, dizziness, headache, and weakness. The classic diagnostic criteria (Whipple's triad) is hypoglycemic symptoms, fasting hypoglycemic (<45 mg/dL) and reversal of changes with glucose.
The treatment is surgical, except in advanced metastatic disease, where streptozotocin is helpful. Enucleation is performed for solitary insulinoma and pancreas resection is performed for multiple insulinomas. Sometimes, ultrasonography intra operative is useful to determine the insulinoma location. The surgery can be done by laparotomy or laparoscopic method. The benefit of laparoscopic surgery are: Small incisions, less pain, faster mobilization, short hospitalization and better cosmetic. On the other side, laparoscopic pancreatectomy should be done by experienced surgeon with availability of supporting instruments. This insulinoma case was in a 39 year old woman. The locations were in body and tail pancreas. Laparoscopic distal pancreatectomy with spleen preservation was done successfully. The duration of operation was approximately 3.5 hours. Post-operative care was done in ICU, for one day. We start enteral nutrition on the third day post operative and the patient may leave hospital on the fifth day post operative.
Chernikovsky I L, Artem Gavriliukov
St. Petersburg Cancer Center, Russia
Title: Laparoscopic surgery vs. open surgery in elderly patients with colorectal cancer
Time : 12:00-12:20
Biography:
Chernikovsky I L graduated from the St. Petersburg Medical University in 2001. He completed his Doctorate in 2008. The theme of his work was Transanal Endoscopic Microsurgery Villous Tumors of the Rectum. He is working as a Surgeon-Oncologist since 2008. He is the Head of the Department of Coloproctology in St. Petersburg Cancer Center since 2011. His main professional interest is a minimally invasive surgical technique in the treatment of colorectal cancer. He devoted much time and effort for the introduction of laparoscopic surgery in different cities of Russia. He has more than 45 published scientific articles in the Russian medical journals.
Abstract:
Actuality: Age is one of the major factors of the risk of death from colorectal cancer. The place of laparoscopic radical surgery in elderly patients with colorectal cancer is still being studied.
Objective: To assess our experience of surgical treatment of elderly patients with colorectal cancer.
Materials & Methods: 106 patients older than 75 years with colorectal cancer were divided into 2 groups: 66 patients underwent traditional surgery and 40 underwent laparoscopic surgery.
Results: The average duration of operation in laparoscopic group was significantly lower (127 minutes vs. 146 minutes). Intraoperative blood loss was 167 ml against 109 ml respectively, but the differences were not significant (p=0.36). The quality of lymph node dissection and an adequate amount of resection between two groups did not differ significantly. The average hospital stay was not significantly lower in the laparoscopic group (p=0.43). Complications occurred in both groups with the same frequency (13.6% vs. 15.0%), which did not exceed the average in the other age groups. Median follow-up was 16 months (6 - 30 months). The number of deaths among patients operated traditionally was twice more than in the laparoscopic group. However, the differences did not reach statistical significance.
Conclusions: The frequency of postoperative complications and postoperative mortality among elderly patients with colorectal cancer is not more than average and does not depend on age. In terms of intraoperative blood loss, radical intervention and the quality of lymph node dissection, both groups are comparable. Laparoscopic surgery is faster than traditional, but, however, it gives no benefit in reducing the average hospital stay and the number of complications in the laparoscopic group. Selection of surgical access does not affect the quality of life of patients after discharge. There was a tendency of increasing of mortality in the long term from non-colorectal cancer causes and as a result, reducing overall survival among elderly patients who were operated in traditional way.
K Sendhil Kumar
Gateway Clinic and Hospital, India
Title: Laparoscopic Management of an Unusual cause of Massive Upper Gastrointestinal Bleeding
Biography:
K Sendhil Kumar is the Director and Chairman of Gateway Clinics and Hospital. He is renowned Gastroenterologist of the country and has vast experience in the field of advanced laparoscopic surgery. He has various presentation and publication national and international on his name
Abstract:
Lipoma of the stomach is a rare tumor. A majority of these tumors were managed by endoscopic and open surgical intervention, with few data published which were managed by total laparoscopy for massive bleeding from huge gastric lipoma. We report a case of a 67-year-old man with massive upper gastrointestinal bleeding who was diagnosed as having a large bleeding gastric lipoma that was managed successfully with laparoscopic excision. Lipomas are benign tumours of adipose tissue. Gastric lipomas are rare and account for less than 1% of all tumors of the stomach and 5% of all gastrointestinal lipomas. They typically occur in the 5th or 6th decade of life with equal sex incidences and 75% occur in the antral region in the submucosa or serosal layers. They are usually asymptomatic and are commonly detected incidentally; however, they may present with gastric outlet obstruction and upper gastrointestinal bleeding. Approximately 220 cases have been reported in the medical literature and further only three cases have been reported presenting with massive upper gastrointestinal haemorrhage. A case of gastric lipoma with massive GI bleed is reported and relevant management options and differential diagnosis discussed.
Biography:
Chief of the Surgery Department (won in public contest) Jorge Reategui Delgado
Hospital II – EsSalud, Piura January 2006 – Presently
Chief of Surgery Service Jorge Reategui Delgado Hospital II – EsSalud, Piura
July 2004 – December 2005
Medical Manager, Assistential – EsSalud Piura - April 23th – June 15th, 2004
Director of Jorge Reategui Delgado Hospital – EsSalud – Piura September 07,
2001 – April 22nd, 2004
General Director, Regional Direction of Health, Piura October 14th, 2000 –
February 14th, 2001
Director, Jorge Reategui Delgado Hospital – EsSalud, Piura September 07th,
1998 – October 29th, 1999
Director, Sullana Hospital July 26th, 1988 – December 1990
Director, La Unión PoliclÃnic and July 1st 1983 – December 31st, 1985
Abstract:
Biography:
Hegazy graduated from Faculty of Medicine, Ain Shams University in Cairo on Dec.1982 ( excellent with honor ). He got his Master degree in Pediatrics from the same University in 1987. He became certified by the American Board of Pediatrics in 1994 after finishing 3 years of pediatric residency in Akron, Ohio. He is a fellow of the American Academy of Pediatrics since 1994. He also did a one year neonatology fellowship in Kosair Children's Hospital in Louisville, Kentucky. He continued his career in the faculty staff of Children's Hospital , Ain Shams University in Cairo and he is currently serving as a Professor of Pediatrics and Neonatology in the same University since 2005. He has more than thirty local and international publications in the field of pediatrics and neonatology.
Abstract:
Chernikovsky I L, Artem Gavriliukov
St. Petersburg Cancer Center, Russia
Title: Laparoscopic surgery vs. traditional surgery in patients with locally advanced colorectal cancer
Biography:
Chernikovsky I L Graduated from the St. Petersburg Medical University in 2001. He completed his Doctorate in 2008. The theme of his work was transanal endoscopic microsurgery villous tumors of the rectum. He is working as a surgeon-oncologist since 2008. He is the Head of the Department of Coloproctology in St. Petersburg Cancer Center since 2011. His main professional interest is a minimally invasive surgical technique in the treatment of colorectal cancer. He devoted much time and effort for the introduction of laparoscopic surgery in different cities of Russia. He has more than 45 published scientific articles in the Russian medical journals.
Abstract:
Introduction: The expediency of the application of laparoscopic surgery in locally advanced colorectal cancer remains controversial. The aim of our study was to evaluate the safety and efficacy of laparoscopic multi-visceral resections for cancer of the colon and rectum.
Materials & methods: The study included 86 patients with tumors of the colon or rectum with the degree of invasion. T4b was operated during the period from 2013 to 2015. Laparoscopic and traditional surgery for tumors of the colon and rectum with invasion of the adjacent organs was carried out for 42 and 44 patients respectively.
Results: The following procedures were performed laparoscopically: 10 patients (23.8%) underwent laparoscopic bowel resection, combined with hysterectomy with appendages, 5 (11.9%)-combined with liver resection, 5 (11.9%)-with adnexectomy, 5 (11.9%)-with small bowel resection, 2 (4.8%)-with splenectomy, 3 (7.1%)-with atypical gastric resection, 2 (4.8%)-with the resection of the ureter, 2 (4.8%)-with nephrectomy and 5 (11.9%)-with the resection of the bladder. Three (7.1%) patients underwent laparoscopic pelvic exenteration. Conversion of the access during laparoscopy was performed in 4 (9.6%) patients. The average amount of blood loss during laparoscopic operations was 205 ml as compared with traditional system which had 480 ml of blood loss. Mean operative time was 201 minutes and 150 minutes respectively. R0 resection was achieved in 100% of the cases. The average number of examined lymph nodes in the two groups was 14. The average length of patient stay in the hospital was 15 days after laparoscopic surgery and 23 days after traditional surgery. Postoperative complications were 22% (8) and 13% (6) respectively. Reliable invasion according to the morphological study in both groups was 56 and 61%. In other cases, there were infiltrations or perifocal inflammation passing to adjacent organs.
Conclusions: Laparoscopic multiorgan resections of colon and rectum cancer are effective in terms of oncological radicality. The volume of blood loss and length of postoperative period was significantly lower in the laparoscopic group than in traditional surgery group.
Nuria Perez y Lopez
Gastroenterology Hospital Angeles, Mexico
Title: Clinical Response in Mexican Patients with IBS Treated With low food map diet
Biography:
Abstract:
Background: A low flatulogenic diet is thought to decrease the colon fermentation and improves gas related symptoms in patients with irritable bowel syndrome (IBS).
Aims: Evaluate clinical response in population with IBS treated with low FODMAPs diet.
Methods: The effect of low FODMAPs diet was evaluated in patients with the diagnosis of IBS based con Rome III criteria during a treatment period of 21 days evaluating clinical response of abdominal pain, bloating and flatulence by a Visual Analogue Scale. The stool form was evaluated with the Bristol Scale. Also the global satisfaction was obtained. The results were analyzed by averages, 95% CI and T Student.
Results: 31 patients were included, 87% females. The mean age was 46.48 years. The IBS subtypes distribution was: constipation 64.5%, diarrhoea 22.6% and mixed 12.9%. The average score for abdominal pain before diet was 6.0 (95% CI 5.04-6.96), for abdominal bloating 7.10 (95% CI 6.13-8.06) and for flatulence 5.94 (95% CI 4.79-7.08). The average score for abdominal pain after diet was 2.77 (95% CI 1.60-3.95) (p< 0.001), for bloating 4.19 (95% CI 2.95-5.44) (p<0.001) and for flatulence 3.06 (95% CI 1.99-4.14)(p<0.001). For stool form the Bristol Scale before diet was 3.68 (95% CI 3.14-4.22) and after diet 4.10 (95% CI 3.66-4.54) (p=0.1). The patient satisfaction was 70.9%.
Conclusions: The more prevalent IBS subtype was IBS-C. There was significant improvement in the 3 evaluated symptoms; however we don’t find stool form improvement.
Latif Bagwan
Gateway Clinic and Hospital, India
Title: Laparoscopic Repair of Incarcerated Bochdalek Hernia in Elderly. A Rare Emergency Easily Overlooked
Biography:
Latif Bagwan is the Consultant Laparoscopic Surgeon and Endoscopist in Gateway Clinics and Hospital. He is a part of many national and international societies. He is working in the profile for more than a decade.
Abstract:
Congenital posterolateral diaphragmatic defects, such as Bochdalek hernias (BHs), usually present during the neonatal period with respiratory symptoms and are associated with significant mortality. However, a subset of patients with BHs may remain asymptomatic during childhood, and the condition may present as a surgical emergency in adulthood. Surgical repair of the defect is the recommended therapy for all patients with BHs, regardless of the presence of symptoms. Traditionally, the repair of diaphragmatic defects has been performed via laparotomy or thoracotomy, but the use of laparoscopy has challenged the use of these traditional procedures. However, the laparoscopic management of incarcerated BH is rarely reported. In the present paper, we report the case of a patient who presented gastric volvulus that was caused by an incarcerated stomach through a Bochdalek defect and treated using a laparoscopic approach.
Mohammad Hayssam Elfawal
BSC - Bariatric Surgery Clinic, Lebanon
Title: Obesity surgery in the awake: Is it feasible?
Biography:
Diploma in Laparoscopic Surgery: University of Paul Sabatier –Lille / France in year 1998 Diploma in General Surgery: American University of Beirut in year 2001. Member in the EAES in the year 2003. Clinical Instructor in the Arabic University of Beirut since year 2005. Diploma in Hepato-biliary and transplant surgery : University of Paris -6- / France in year 2003 Fellow in the American college of Surgeons since year 2011 Close
Abstract:
Obesity is a chronic and progressive disease, associated with related metabolic disorders, causing severe morbidity and mortality around the globe. Sleeve gastrectomy is being performed with increasing frequency in the world for the treatment of morbid obesity. General anaesthesia carries a significant risk in the obese individual and especially those who had metabolic syndrome (diabetes hypertension or coronary artery disease). We started in the bariatric surgery clinic (BSC) in Makassed hospital in Beirut to do sleeve gastrectomy under block anaesthesia (awake patient) in the year 2010 for the first time in the world. Thereafter we did 35 cases of sleeve under block. We report hereby our results in terms of safety efficacy and resolution of comorbidities after 3 years of follow up.
Luis Hernandez-Higareda
Hospital Angeles del Pedregal, Mexico
Title: Therapeutic endoscopy in trauma
Biography:
Luis Hernandez-Higareda completed his Pre-grade in Biological Sciences from Cyto-histopathology Clinic and Medicine from Faculty of Medicine at the University of Guadalajara. He did his Post-graduation in Intensive Care, Clinical Epidemiology, and Master of Surgery from National Medical Center West, Mexican Social Security Institute (IMSS) from University of Guadalajara. He has undergone training in Gastrointestinal and Airway Endoscopy and Thoracoscopy, National Medical Center La Raza, IMSS, National Autonomous University of Mexico (UNAM). He completed courses on General Surgery and Endoscopic Ultrasound from XXI Century National Medical Center IMSS, UNAM. He got trained in Surgery of Trauma from Trauma Hospital Lomas Verdes IMSS, UNAM.
Abstract:
Introduction: Therapeutic endoscopy has helped prevent many surgical procedures with the idea of minimally invasive surgery. It has demonstrated effectiveness in the bile duct and endoscopic ultrasound among others.
Objective: The problem of serious trauma patient is that they are usually treated at trauma hospitals where there is no such resource. On the other hand, where endoscopy is performed at high-level, no experience in the management of severe trauma patients does not warrant a quick response.
Materials & Methods: We present among others, a series of trauma cases, each distinct in the problem and all managed successfully with endoscopy, avoiding major surgical procedures. We present the experience of some cases in a 1st level trauma center hospital divided into four groups, which underwent gastro esophageal endoscopy (12 procedures), sigmoidoscopy (3), bronchoscopy (4) and endoscopy into gastrostomy (2). Among them, the cases were: A young patient with bleeding from diverticular disease, another patient with gastrostomy retrograde endoscopy, another one with intestinal perforations, one with failure to pass the tracheostomy tube (because of an anatomical variant modified by trauma), one with pyloric obstruction and reflux, and one with neck surgery fixing that did not allow the passage of nasoenteral tube without endoscopic aid.
Results: All cases were resolved with the help of the endoscope.
Conclusion: Therapeutic endoscopy in trauma should be part of the armamentarium of the hospitals where trauma patients are cared.
- Gastrointestinal Carcinogenesis and Therapeutics | Inflammatory Bowel Disease Research vs Treatment / Management | Gastrointestinal Bleeding- Treatment and Management (Contd.)
Location: Salon II III
Chair
Mitsunori Yasuda
Kyoto Prefectural University of Medicine, Japan
Co-Chair
Errawan R Wiradisuria
Indonesian Society of Endo-Laparoscopic Surgeons, Indonesia
Session Introduction
Pawan Mathur
Royal Free London NHS Fundation Trust, UK
Title: State of the art in Minimally Invasive Colorectal Surgery [MICS]
Biography:
Pawan Mathur, MS FRCS [Gen Surg], is a General, Colorectal & Laparoscopic Surgeon at The Royal Free London NHS Foundation Hospitals. His specialist interest is in colorectal conditions such as haemorrhoids (piles) anal fissures, anal fistulae, ulcerative colitis/Crohn’s disease, pelvic floor conditions and colorectal cancer. He qualified from St. Thomas’ Hospital Medical School in 1990. He undertook a Postgraduate Research degree at the Royal Marsden and Chelsea & Westminster Hospitals and was awarded a MS thesis for his work examining the role of manipulating tumour blood supply on chemotherapeutic drug uptake in colorectal liver metastases. He maintains an active interest in surgical research and continues to publish in peer-reviewed journals. In this regard, he is Clinical Research Lead for Surgery in the Trust. He is currently the Principal Investigator on a variety of randomized surgical clinical trials. He also holds an Honarary Senior Lectureship at UCL Medical School, which allows him to pursue his main research interest in colorectal cancer.
Abstract:
The author will aim to demonstrate the role of MICS in the modern day management of colrectal cancer (CRC). There will be a discussion regarding the central role of multi disciplinary meetings (MDTs) in the manageemnt of CRC, the reasons why they exist, who is involved and evidence of their efficacy and outcomes. The increasing role of laparoscopic colorectal surgery will be discussed in terms of CRC management. Up to date RCT evidence will be presented of both colon and rectal cancer surgery. The alternate routes of minimally invasive access will be presented (single incision laparoscopic surgery (SILS), natural orifice extraction surgery (NOSES) and hybrid laparoscopic-endoscopic techniques). Evidences, where it exists, will be discussed. The role of robotic colorectal surgery will be discussed and randomised evidence in rectal cancer surgery will be (ROLLAR) prsesented. Results of a prospective study of patiet preference in terms of surgical access routes will be presented. The management of early rectal cancer will be discussed with trans-anal endocscopic microsurgery (TEMS) and trans anal microscopic invasive surgery (TaMIS) techniques. The role of endoscopic mucosal/ serosal resection (EMR/ ESR) will also be discussed in the management of early CRC. The future of MICS is discussed with a projection that this may look like going into 2017/2018.
Lui Ka Luen
The Chinese University of Hong Kong, China
Title: Endoscopic submucosal dissection: Prospectives on complication prevention and medical comorbidites
Biography:
Lui Ka Luen was graduated from the University of Hong Kong in 2004 with distinction in Medicine. He is a specialist in Gastroenterology in Hong Kong and is awarded fellow of the Hong Kong College of Physician in 2012. Then, he further pursued his career on imaging enhanced endoscopy, endoscopic ultrasound, endoscopic submucosal dissection and submucosal tunnel dissection in Japan under direct mentorship of Professor Takashi Toyonaga. He is now an honorary Clinical Assistant Professor at the Chinese University of Hong Kong. He also published paper and invited speaker in various local and international journals, conferences and meetings.
Abstract:
The endoscopic submucosal dissection is the standard of care for the management of early malignant or premalignant neoplasm in the gastrointestinal tract. However, patients with these lesions are often accompanied with significant medical comorbidities. Such as, patients on oral anticoagulation with high thrombotic risk e.g., mitral valve replacement, dual valve replacement, recent myocardial infarction with intervention, end stage renal failure, poorly controlled diabetes, conditions with high anesthetic risk, etc. Patients with these high-risk medical conditions often increase both endoscopic and non-endoscopic complication rate. Combination of careful optimization of medical condition, pre-endoscopic preparation, special endoscopic technique and post-endoscopic management is a must to acheive low complication rate for these high risk population. Endoscopic techniques for prevention of rebleeding included careful identification of all vessels under indigo carmen-free submucosal plane, precoagulation of big vessels, submucosal dissection using coagulation mode, liberal use of coagulation forceps to eradicate all vessel heads at the post ESD wound and prophylactic closure of post ESD wound. Endoscopic techniques for prevention of perforation included maintainance of a good and clear view (Only cut when you see) in an indigo carmen free submucosal plane and prevention of any active bleeding, maintainance of the direction of knife parallel to muscle layer and the direction of cutting away from the muscle layer together with a good traction and slight hooking of tissue (ball-tube type of knife) especially when the direction of knife is perpendicular to the muscle layer. Use of coagulation mode for submucosal dissection is also the key.
Vikas Balasheb Jadhav
Dr. D. Y. Patil Vidyapeeth, India
Title: Trans-abdominal sonography of the small & large intestines
Biography:
Vikas Leelavati Balasaheb Jadhav has completed Postgraduation in Radiology in 1994. He has a 19 Years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He has four Indian Patents & an International Patent published on his name in the field of Gastro-Intestinal Tract Sonography & the Radiology, since 2008. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 20 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist & the Specialist in Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.
Abstract:
Trans-abdominal sonography of the small & large intestines can reveal many diseases like bacterial & viral entero-colitis, an ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & structure. polyps & diverticulum, benign intra-mural tumours, intra-mural haematoma, intestinal ascariasis, foreign body, necrotizing entero-colitis, tuberculosis, intussusception, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, complications of an inflammatory bowel disease – perforation, structure. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature with enlargement of the involved segment. Shouldering effect at the ends of stricture is most common feature. Primary arising from wall itself & secondary are invasion from adjacent malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy. Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant gastro-intestinal tract lesions, so should be the investigation of choice.
Hamzaoui Lamine
University of Tunis El Manar, Tunisia
Title: Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease
Biography:
Gastric Outlet Obstruction (GOO) related to Peptic Ulcer Disease (PUD) is a rare complication which has traditionally been treated by surgery. Endoscopic Balloon Dilatation (EBD) has been shown to be an effective and safe procedure, particularly in elderly patients and/or patients at high risk of surgery. The aim of the study was to describe epidemiological, clinical and endoscopic characteristics of GOO secondary to PUD and to evaluate the effectiveness, safety and outcome of EBD. Between 1999 and 2009, 45 patients consisting of 38 male, 7 female with a median age 51.9 years (range 20-85 years) underwent balloon dilatation; after persistence of pylorobulbar stenosis despite medical treatment with proton-pump inhibitor intravenously for 7-10 days. Symptomatic relief was obtained immediately in 95.5% with clinical remission in 84.4% of patients. The procedure was complicated in 3 patients (6.7%, two perforations and one case of bleeding). Helicobacter Pylori (H. pylori) was found in 97.7% of patients and eradication therapy was prescribed. The median follow-up was for 32 months (range between 4-126 months). Remission without relapse was observed in 55.8% of cases, 30 months after dilatation and H. pylori was eradicated in 78.8% of observed cases. Stenosis relapsed in 15 patients (39.5%) after a median period of 22.9 months. Smoking and failure of H. pylori eradication were associated with relapse of stenosis. Hence, the study showed that EBD was an effective and safe therapeutic method for GOO related to PUD with short and long term remission.
Abstract:
Hamzaoui is an Assistant Professor in Gastroenterology department of the University Hospital Mohamed Taher Maamouri (Nabeul, Tunisia). He is also a Teacher in Faculty of Medicine of Tunis (University of Tunis-El Manar, Tunisia). He has published many papers in the field of Gastroenterology and Hepatology.
Shahira El-Etreby
Mansoura University, Egypt
Title: Validation of plasma proteasome as a tumor biomarker for diagnosis of hepatocellular carcinoma
Biography:
Shahira El-Etreby has done her specialization in Internal Medicine in the year 2006. Currently, she is an Assistant Professor in Hepatology and Gastroenterology, Mansoura University, Egypt.
Abstract:
Background & Aim: Early diagnosis of Hepatocellular Carcinoma (HCC) improves prognosis. While many studies revealed that alpha-fetoprotein (AFP) is a poor HCC biomarker, more recent studies nominated Plasma Proteasome (PP) as a promising one. So, our aim is to evaluate diagnostic accuracy of PP level as a tumor biomarker for diagnosis of early HCC in Egyptian patients with liver cirrhosis and to validate it on a large population.
Methods: This study enrolled 120 patients with hepatitis C virus related cirrhosis (60 with HCC and 60 without HCC) versus 60 healthy controls. HCC patients were subdivided into 3 groups according to tumor burden. PP level and AFP were assessed. Then, validation of these results on large number of HCC population (308 cases) was done.
Results: It was observed that, 200 ng/ml of AFP showed sensitivity for only 40.1%. On the other hand, AUC of PP was 0.883 (0.829-0.938), with cutoff value of 1.1 μg/ml having sensitivity of 98.3%, and specificity of 71.25%. There was no statistically significant correlation between the level of PP and tumor size, portal invasion or tumor stage (p values = 0.89, 0.07, and 0.82, respectively). Validation of these results on 308 patients yielded sensitivity of 95.12% and specificity of 60%.
Conclusions: PP level could be a promising biomarker for early HCC diagnosis in cirrhotic patients.
Monir H. Bahgat
Mansoura University, Egypt
Title: Albumin infusion in chronic liver disease: The current challenges
Biography:
Monir H Bahgat has done his specialization in Internal Medicine in the year 1995. Currently, he is a Professor of Hepatology and Gastroenterology (Internal Medicine department), Manoura University, Egypt. He is a member of EASL and IASL
Abstract:
The human body contains 4-5 g/kg of albumin. This amount is largely distributed in the extracellular space; with a plasma concentration of 4-5 g/dl. It is responsible for almost 80% of the osmotic pressure of the plasma. Therefore, Human Albumin Solution (HAS) has been used as a physiological plasma expander. However, its limited availability and high cost make it essential to define recommendations for its appropriate use. Numerous studies have been done on the uses of HAS, which sometimes reached inconsistent conclusions. However, most of the appropriate uses of HAS are related to the management of complications of Chronic Liver Disease (CLD), including ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome. So, all the current recommendations and challenges encountered during the use of HAS in the management of complicated CLD will be reviewed, including the appropriate indications, different dosing regimens, possible complications, and alternatives. In addition, occasionally appropriate, inappropriate or controversial uses of HAS will also be reviewed.
Nesreen Khidir
Hamad Medical Corporation, Qatar
Title: Laparoscopic sleeve gastrectomy effect on pre-diabetic, diabetic patients with morbid obesity: A comparison between adults and adolescents
Biography:
Nesreen Khidir has completed her MD from Khartoum University in Sudan. She finished her Clinical and Surgical training in General and Laparoscopic Surgery at Hamad Medical Corporation - Qatar (Arab Board for Health Specialization, General Surgery Program 2014). In the year 2014, she has joined Bariatric and Metabolic Surgery department in HMC as a Specialist. She has several presentations and publications at numerous prestigious international symposia and journals. She has also participated in several international Bariatric Laparoscopy and Endoscopy surgery conferences and courses as a candidate, a speaker and an instructor.
Abstract:
Introduction: The prevalence of obesity is rising epidemically in Qatar population. Recent studies revealed that 42% of all Qataris are obese with 7.9% prevalence in adolescents. Treatment of pre-diabetes particularly in adolescent population can potentially reduce the risk of developing future diabetes.
Aim: Primary outcome: Comparing the outcomes of Laparoscopic Sleeve Gastrectomy (LSG) in adult vs. adolescent patients in terms of weight loss i.e. BMI and percentage excess loss (%EWL) at 6-12 months. The Secondary outcome: Comparing the effect on comorbidities (diabetes, pre-diabetes and obstructive sleep apnea), complications rate, patients’ post-surgery behavioral compliance and satisfaction.
Method: Analysis of retrospective data of 139 adult vs. 91 adolescent patients 6-12 months post-operatively.
Result: LSG in 139 adults vs. 91 adolescents; 77% vs. 86% were Qataris, aged 37.4±11.4 SD vs. 17±1.5 SD, pre-operative BMI: 48.4± 8.7 vs. 47.6±7.5. Post-operative outcomes at 6-12 months showed BMI: 33.48±6.9SD vs. 36.4±7.25 SD, %EWL: 66.7±26 vs. 50.5±26.8 for adolescents. Applying the American diabetes association guidelines for diagnosing and treating diabetes in both age groups revealed that about 47 vs. 32 patients were diabetic, their mean pre-operative HbA1c dropped from 8.2±1.87 SD to 6.12± 0.089 SD (P value: 0.0001) vs. pre-operative HbA1c 10.3±3.57 SD dropped to 6.2±1.158 SD (P value: 0.0142). About 67.5% vs. 57% were cured. Pre-diabetic patients 33 vs. 32, their mean pre-operative Hba1c dropped from: 5.94±0.22 SD to 5.24±0.34 SD (P value: 0.0001) vs. 5.78+0.328 to 5.28+0.329SD (P value: 0.0001). All adult prediabetes normalized their HbA1c level vs. 96.4% for adolescents. Complications occurred in both groups; (3.5% vs. 4.4%) e.g. post-operative bleeding (2 vs. 0 patients), leak (1 vs. 0), surgical site infection (1 vs. 1). One adult patient developed stenosis and had gastric bypass at a later stage. Three adolescent patients had post-LSG stenosis and managed successfully with endoscopic dilatations.
Conclusion: At 12 months operatively, LSG shows results comparable in adult and adolescent patients in terms of BMI, %EWL and complications. LSG is effective in preventing and treating diabetes and prediabetes in both age groups.
K Sendhil Kumar
Gateway Clinic, India
Title: Thoracolaproscopic esophagectomy: Our early experience and outcome
Biography:
K Sendhil Kumar is the Director and Chairman of Gateway Clinic in TN, India. He is a renewed Gastroenterologist of the country and has vast experience in the field of Advanced Laparoscopic Surgery. He has various publications in national and international journals.
Abstract:
Advances in technology have allowed us to explore the possibility of performing Esophagectomy using minimal invasive surgical technique. Minimal invasive esophageal surgery has the potential to improve morbidity, mortality, hospital stay and functional outcomes when compared with open method. Although technically complex, combined laparoscopic and thoracoscopic esophageal resection is feasible. A case series of 50 cases who underwent total thoracolaproscopic esopahgectomy were presented. The purpose was to evaluate early results with thoracolaproscopic esopahgectomy for malignant disease. Then the age, gender, indication for surgery, blood loss, hospital length of stay, post operative complication, mortality was recorded. It can be concluded that Thoracolaproscopic esopahgectomy is complex and technically difficult, but it’s safe in experience hand. Despite long time, patient do well and benefit from a shorter stay and more rapid recovery compared with open esopahgectomy. Its role as a curative cancer procedure is still unknown. Here we present the video of total thoracolaproscopic esopahgectomy.
Biography:
Hasan Ahmed El-Garem has completed his MD from Faculty of Medicine, Cairo University and Post-doctoral studies from Amsterdam Medical Centre. He is a Professor of Gastroenterology & Hepatology at Faculty of Medicine, Cairo University. He has published more than 25 papers in reputed journals
Abstract:
Egypt has the highest prevalence of hepatitis C virus infection in the world. The prevalence of HCV viremia was estimated to be 7.3%, and 90% of them have genotype 4. Until 2007, hepatitis C virus treatment was not offered by the government. In 2007, an Egyptian National Committee for Control of Viral Hepatitis (NCCVH) has been established. Number of patients treated with PEG-INF and ribavirin was 350,000. A further step in treating HCV was FDA approval of Sofosbuvir in 2013. Egyptian government made an agreement with the manufacturer company Gilead to decrease the cost of the course for 3 months from 84000$ to 900$. New treatment protocol started in September 2014. The protocol categorized patients into 2 groups: Group 1 - Patients who were eligible to receive interferon were treated with daily Sofosbuvir (400 mg) and weight-based ribavirin plus weekly peginterferon for 12 weeks and Group 2 - Patients who were not eligible to receive interferon were treated by daily sofosbuvir (400 mg) plus weight-based ribavirin for 24 weeks. A further step in treating HCV was achieved after availability of the new drugs, daclatasvir and ritonavir boosted paritaprevir/ombitasvir in Egypt. Treatment protocol was updated in November 2015. Patients were categorized into 4 groups: 1 - Easy to treat group, was treated by the following regimen for 12 weeks; sofosbuvir (400 mg) plus daclatasvir (60 mg). 2 - Difficult to treat group, was treated by the following regimen for 12 weeks; sofosbuvir (400 mg) plus daclatasvir (60 mg) plus ribavirin (600 mg up to 1000 mg). 3 - Third regimen was for patients with post organ transplantation and patients who failed previous sofosbuvir containing regimen. These patients were treated by the following regimen for 24 weeks; sofosbuvir (400 mg) plus daclatasvir (60 mg) plus ribavirin (600 mg up to 1000 mg). 4 - Fourth regimen for patients with glomerular filtration rate less than 30 ml/min were treated by ritonavir boosted paritaprevir/ombitasvir plus ribavirin for 12 weeks. Results of treatment will be mentioned in the presentation.