11^th Global Gastroenterologists Meeting June 12-13, 2017 Hotel Holiday Inn Rome Aurelia Via Aurelia Km 8400, Rome, Italy

Biography:

Abstract:

Gastroesophageal reflux is a condition that occurs when gastric (GERD) or gastroduodenal (EDRD) content refluxes into the esophagus.  Depending upon the degree to which duodenal secretions contaminate the gastric refluxate the refluxed material can be acidic (pH less than 4 for gastric reflux), mildly acidic (pH ranging between 4 but < 7, mildly ascitic), or alkaline (pH greater or equal 7).  The patient's symptoms are a reflection of the degree of tissue inflammation plus or minus tissue injury (erosions or ulceration) produced rather than the specific nature of the refluxed material.  Continued uncontroled/chronic reflux leads to the complications of GERD/GDRD consisting of inflammation that can progress to erosions, ulcerations, or scarring (stricture), mucosal metaplasia (Barrett's esophagus) or adenocarcinoma.

GERD is a common disorder with a world prevalence that somewhat between 10 and 30% of the population being less commonly seen in Asia as compared to Europe or the Americas.  Clinical GERD is estimated to be seen in 7% of the population is  manifested as  ‘ heartburn" and accounts for 4% of the visits to primary care physicians and is the most common reason for referral to gastroenterologist.

Complicated GERD is manifested by “alarm signals” consisting of weight loss, odynophagia, dysphagia, regurgitation, anemia and a variety of extra- esophageal symptoms ascribed to GERD consisting of hoarseness, laryngitis, bronchitis, dental enamel erosion, otitis media, sinusitis, pseudo- angina, sleep dysfunction, asthma, pneumonitis, and pulmonary fibrosis.  In addition, as a consequence of the almost universal use of proton pump inhibitors for the treatment of GERD an increase in cases of community-acquired and hospital-acquired pneumonia have been reported in the elderly as a direct consequence of the reduction in the acid secretion by the stomach and the resultant increase in viable gastric microbial concentrations.

Risk factors for GERD are common in the population and consist of the existence of a hiatal hernia, obesity, type 2 diabetes mellitus, hypertension, hyperlipidemia, advanced age, chronic hiccups, asthma, and less often sinusitis, chronic recurrent otitis media and dental erosions.  Because heartburn can be treated very effectively with proton pump inhibitors there is no need for endoscopy or other invasive diagnostic procedures to establish a diagnosis in cases of simple heartburn, GERD, or GERD.  The use of endoscopy, pH monitoring, with without impedance determination, and esophageal manometry are reserved for those individuals manifesting "alarm symptoms", those who have failed treatment with a proton pump inhibitor and those being considered for reflux surgery.  Endoscopy is used to grade the severity of reflux inflammation and the identification of erosions or ulcerative disease and assess the patient for the more severe or advanced complications consisting of stricturing, Barrett's esophagus and/or adenocarcinoma.  Ambulatory pH monitoring is used to document reflux and define its character (acid, mildly acid, or alkaline), its frequency, and duration as well as its relationship with symptoms as reported by the patient.  Manometry enables a quantitative assessment of esophageal motility and measurement of the frequency of transient esophageal relaxations, and the duration of the reflux exposure as well as the ability to rule out the presence of achalasia, a contraindication to reflux surgery.

Reproducible therapies of GERD consist of the administration of proton pump inhibitor taken one to 2 hours before the first meal of the day for 12 weeks.  Failure to respond to find a symptomatic relief is managed by a doubling of the morning  proton pump inhibitor dose with or without the addition of an H2 receptor antagonist at that time which is utilized particularly for those with nocturnal reflux symptoms or sleep apnea.

Prokinetic agents are used exclusively when alkaline reflux is present to prevent alkaline reflux by increasing esophageal contractions (esophageal clearance), to increase lower esophageal resting pressure to prevent reflux ,  and enhancement of gastric and duodenal motility there by reducing the volume of gastric/duodenal content available for reflux.  The use of these agents is limited by the development of tolerance within a short period of time, their short duration of action, and their adverse effects consisting of tremor, fatigue and cardiac arrhythmias. 

A large number of abnormal anatomic variations at the gastroesophageal junction and physiologic and neuroendocrine reflexes occur  as high frequency in cases of GERD and our thought  to contribute to the pathophysiology of the disorder.  Disease consist in part consist of lower esophageal sphincter incompetence, reduced resting lower esophageal pressure, the presence of a hiatal hernia, reduced esophageal clearance, increased frequency of transient esophageal relaxations, esophageal, gastric and/or duodenal motility disorders.  With the exception of surgical repair of anatomic variants, the identification of these abnormalities has not contributed substantially to the treatment of GERD/GDRD.  This is particularly true of the research directed at the identification of neuro- and endocrine mechanisms that could contribute to esophageal dysfunction and reflux.

For those who fail extended proton pump therapy or develop complications including an esophageal stricture, Barrett's esophagus, esophageal cancer, chronic intractable reflux symptoms often manifested as chronic hiccups, or morbid obesity, surgery is the treatment of choice and consists of any variation of the Nyssen procedure done laparoscopically or any of the variations bariatric surgery.  These surgical procedures produce long-term benefit but often with minor relapses that necessitate the use of an additional acid inhibitory agent for a PPI or H2 receptor antagonists and occasionally a prokinetic agent as well.

Recently, a large variety of endoscopic procedures consisting suturing the lower esophageal sphincter, Silastic implants and endoscopic fundoplication have been developed with for use in the treatment of GERD, but these agents are agents are still investigational and have not yet obtained FDA approved

Biography:

He graduated in medicine and surgery, on 11/12/1981. The same year he entered graduate school in Digestive System Diseases directed by Prof.Aldo Torsoli, working in particular with his young researcher, now a professor of gastroenterology in Rome: prof. Enrico Corazziari. Since then I have always been interested in the study of the pathophysiology of the Digestive Tract and neurogastroenterology. Up to now, he focus my studies on organic and functional disorders of the digestive system. For years he work with the best specialists in every sector and structure, public and private, to understand and solve a 360 ° diagnostic and therapeutic issues of Gastroenterology.

He have to my credit numerous publications and participation at conferences. He maintain, the beginning of specialization, the study of the motility of the Digestive Tract.

He always run Digestive standard manometry, pH-metry, pH-Impedance, CH4 H2-Breath Test, Pelvic Floor Rehabilitation (pelviperineale pain urogineproctologico origin, urinary incontinence, obstructed defecation syndrome, fecal incontinence, etc.) its rehabilitation treatment.

Currently, in October 2014, my army activities at the Clinica Pio XI, Via Aurelia 559 Rome, with new and sophisticated equipment (manometry HIGH RESOLUTION with a neurological module for EMG).

Abstract:

Biography:

Abstract:

Introduction. American Gastroenterologists Association 2008 guidelines suggests antireflux surgery to be reserved for patients with esophagitis and intolerance to PPI and patients with poor control of the gastro-esophageal reflux symptoms, especially regurgitation. Laparoscopic Nissen-Rossetti fundoplication has become the gold standard, being a well tolerated operations and considering its good outcome in terms of symptoms relief.

Laparoscopic Nissen-Rossetti fundoplication. In 1939 Rudolph Nissen improvised a fundoplication to protect an esophagogastric anastomosis. Some years later he performed this procedure to treat gastro-esophageal reflux disease and published the first description of the procedure in 1956. What we now call Nissen-Rossetti fundoplication is the result of the contribution by Nissen’s favourite pupil, Marco Rossetti. Nissen-Rossetti fundoplication consists in an extensive mobilization of the posterior wall of the stomach, which enables a loose wrap of the anterior wall to be used for the total wrap, without the division of the short gastric vessels. This procedure showed good results in term of post-operative dysphagia. With the extensive application of laparoscopic surgery during the 1990s, the volume of antireflux surgery increased. At the present time Nissen-Rossetti compare favorably in terms of mortality and morbidity with appendectomy and cholecystectomy.

Technological innovations. Where is antireflux surgery going from now on? First of all, robotic-assisted surgery. Although as of now robot-assisted surgery still has an unacceptable high cost for benign pathology, numerous studies are reporting comparable results in terms of outcomes versus laparoscopic surgery.

An interesting new device is LINX^©, or Magnetic Sphincter Augmentation (MSA), a small flexible band of interlinked titanium beads with magnetic cores that works by restoring the continence of the lower esophageal sphincter. This device can be easily placed around the gastro-oesophageal junction in about 30 minutes.However it needs longer follow-up and has some limitation: it can’t be used in hiatal hernias larger than 3 cm, the safety and effectiveness of the LINX device has not been evaluated in patients with Barrett's esophagus or Grade C or D (LA classification) esophagitis and in patients with electrical implants such as pacemakers and defibrillators, or other metallic, abdominal implants.

Conclusions. LNR procedure should be considered the gold standard to treat patient with refractory GERD. 2013 UK REFLUX trial concluded that a surgical policy is probably cost-effective, considering LNR in a 5 years follow-up provided a better health-related quality of life compared with medical management. Waiting for a mininvasive techniques standardisation and long term follow up, patients should be aware of the safeness and feasibility of laparoscopic Nissen-Rossetti fundoplication. 

Biography:

Antonio Iannetti has done his degree in Medicine and Surgery and Specialties in "Gastroenterology" and "Internal Medicine" at the University of Rome. 1980-1983 University of Los Angeles (USA), he is interested endoscopic sclerosis of esophageal varices and retrograde cholangiopancreatography-endoscopically. He is University Professor and Chair of Gastroenterology - University of Rome. He is head of the Digestive Endoscopy Service of the University Hospital Umberto I in Rome. He is an expert of the Ministry of Health for Gastroenterology. 

Abstract:

Introduction: The incidence of gastroesophageal reflux disease in the population of industrialized countries is high and ranges from 20 to 40% in the age groups between 45-64 years, with a further increase in the incidence in the age between 64-74 years. The natural history of the disease requires continuous recrudescence alternated with quiescent phases. In view of these epidemiological data, the importance of the social problem and the high health costs is cleared. It follows the interest of pharmaceutical companies, the companies of electromedical and producing toolkits endoscopic and surgical companies.

Objective: In this session, I intend, with the participation of colleagues internists and surgeons, to make a brief stock of the situation, about the gastro-esophageal reflux disease. I will make a tour of the clinical presentation, the increase of incidence, especially of so-called atypical forms and symptoms of gastro-pharingeal reflux (high reflux), emphasizing how many patients are refractory to therapy. Patients who benefit from medical treatment, they become dependent on care. Whereas, many are young and that medical therapy has adverse side effects, such as anemia, osteoporosis, and infections, is the need for alternative therapies. Physiotherapy global posture, for example, can be a transient and partial support. The ultimate solution is or should be surgical.

Considerations: Surgical therapy makes use of minimally invasive or laparoscopic method, which shortens the hospital stay. But an endoscopic surgery, easy, repeatable, free from postoperative complications, can be performed in day surgery, would be ideal for this type of chronic disease. In reviewing the different techniques, that have been proposed over the last 20 years, I relate the considerations, derived from the international literature. This presentation is concluded by presenting a last device, manufactured in Germany, derived from its precursor, the NDO Plicator, which is making use of the addition of heads polytetrafluoroethylene (PTFE), which retain the suture threads from the traction, exerted by the tissues, seem to improve the seal in time.

Conclusions: I carry scientific studies that have compared the operations, performed with GERD-X Plicator, to surgical interventions of fundoplication, with satisfactory results. My invitation is to continue to seek solutions with endoscopic surgery, which is the most appropriate technique for this type of pathology.

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Biography:

Dr. Andrea Formiga has completed his PhD at the age of 25 years in Milan University Italy. In  2002 he has completed the postdoctoral speciality in general surgery. He is the director of the General Surgery Department of Istituti Clinici Zucchi of Monza (Italy) – Gruppo San Donato.

Member of International Advisory Board for Apollo Endosurgery

He has published many documents in surgical and endoscopic treatments for general surgery and obesity procedures.

He has partecipate to many national and international congresses.

Abstract:

The Endobarrier system is an innovative reversible endoscopic system indicated for the treatment of diabetes mellitus type II and obesity. The duration of treatment is one year.

The process involves a decrease in glycated hemoglobin of 2 points in the year of treatment with reduction and/or elimination of oral hypoglycemic agents and/or units of insulin administered daily, improved lipid profile and liver function tests, reduction of blood pressure, and weight loss of about 40% of excess body weight. The system is totally endoscopic, simulates the effect obtained with a laparoscopic gastric bypass but without making sections and/or removal organ.

Method: From March 2014 to November 2016 we performed 20 placements of Endobarrier system (15 men, 5 women), of whom 16 successfully concluded and extracts, 4 still in progress; 2 System extractions of foreign patients who had undergone placement in other countries (Australia, South Arabia), 1 missed positioning for non-compliant patient anatomy (inability to access the capsule in the duodenal bulb). The average hospital stay of patients was 1 day. The mean age of patients was 46 (24-63 aa) range. All positioning and extraction operations were performed under general anesthesia.

Results: The mean preoperative BMI was 45.8, average BMI 37.8 postoperatively; preoperative Hb A1c 8.9 / postoperative HbA1c 6.6; PA values systolic / diastolic mean preoperative 134 / 85.7, PA values postoperative systolic / diastolic 124.7 / 71.8.

Complications: we found the appearance of a duodenal ulcer bleeding in the vicinity of the metal anchoring system of the system that was treated with medical drugs and with the removal of the system; in the same patient appearance of mild pancreatitis with high levels of amylase (400) and lipase (200) resolved spontaneously after removal.

One hepatic abscess in a foreign patient came to our attention from other structure to which it was addressed in urgency.

Conclusions:

The endoscopic endoluminal treatments are now having great expansion and interest even in the treatment of morbid obesity and diabetes

The Endobarrier System is an innovative totally endoscopic malabsorptive reversible treatment that can have an important role in the treatment of diabetes mellitus type II and obesity.

Our experience has shown the effectiveness and feasibility of Endobarrier system. It remains to evaluate the results in the time after removal.

Biography:

Kenji Sasaki completed his MD and, as an Immunologist, he completed his PhD at Tohoku University School of Medicine. He was trained at Miyagi Cancer Center. He is a Board Certified Fellow and Preceptor of Japan Gastroenterological Endoscopy Society, Board Certified Gastroenterologist of Japanese Society of Gastroenterology, Board Certified Member of the Japanese Society of Internal Medicine and Editorial Board Member of CRIM. He has published several papers on Gastroenterology in international journals and served as a Reviewer for Journal of Medical Microbiology, Journal of Pharmacology & Pharmacotherapeutics and Journal of Gastrointestinal & Digestive System.

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Biography:

Omesh Goyal is working as an Associate Professor in Gastroenterology and Hepatology in a tertiary care institute in northern India. He has done lot of research work on chronic hepatitis C and complications of cirrhosis. His other major interest includes functional bowel disorders and ano-rectal manometry. He is a part of the Indian working group on Chronic Constipation which will formulate guidelines for constipation in India under the leadership of Dr Uday Ghoshal. His research work in has been acclaimed at international level. He won the National Scholar Award at UEG in Sweden and Best paper award in APICON in Hyderabad, India. He is working as an editor of the Journal of Gastrointestinal Infections and is an active member of various academic bodies.

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Anna DePold Hohler is an Associate Professor of Neurology at Boston University School of Medicine.  Her research interests include “Autonomic research in Parkinson’s disease and postural tachycardia syndrome”. She has described the genetic association between POTS and Ehlers Danlos type III. Recently, she has explored gastrointestinal, sleep, and dermatologic disorders in this population. She has numerous publications and is an expert and frequent Reviewer.  She has dozens of publications and serves as an Associate Editor of Continuum, one of the premier neurology journals.  She is the recipient of numerous awards, including army achievement and commendation medals and two meritorious service medals for excellence in clinical and teaching skills while serving on active duty. She also received BUSM’s prestigious Stanley L. Robbins Award for Excellence in Teaching and several Neurology teaching awards, including two from the American Academy of Neurology (AAN). She co-chairs the AAN Quality Safety Subcommittee.

Abstract:

Postural Tachycardia Syndrome (POTS) is associated with a number of systemic effects including gastrointestinal (GI) dysfunction.  The most commonly reported GI symptoms are nausea, irregular bowel movements, abdominal pain, and constipation. Many POTS patients report GI symptoms more than once per week.  They often require a GI specialist. The POTS patients often have gastroparesis or delayed gastric emptying.  GI disturbances are frequent and prolonged in patients with POTS, impacting quality of life. Given the importance of the enteric nervous system to normal GI functioning, the same autonomic impairment leading to POTS may result in abnormal gut motility and ultimately subjective GI discomfort. Treatment of autonomic dysfunction in POTS and dietary changes may improve GI dysfunction associated with POTS. 

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Deog-Yong Lee has completed his Doctor of Veterinary Medicine (DVM) and Ph.D. at Seoul National University. He is a Staff Scientist and team leader of enteric virus team in Division of Enteric Disease, KCDC. He has published more than 100 papers in reputed journals.

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Biography:

Nevena Ilic has completed her MhD in Endocrinology at Belgrade University Medical School in 2009 and Master’s degree in Thyroid Diseases in Italy, 2014. She completed Internal Medicine Specialisation at Military Medical Academy Hospital, Belgrade in 2002. From 2014, she works as Prime Endocrinologist at Euromedik General Hospital, Belgrade, where she organized endocrinology service and several symposiums in Belgrade and Rome, where she was a speaker. She spoke at several international congresses. She has published three papers in reputed journals as a first autor and many papers as the one of co-autors. She is a member of European and Italian Endocrinology Society. 

Abstract:

The gastrointestinal tract is an organ essential for the digestion and extraction of nutrients, but it’s also body’s largest endocrine organ. First discovered hormones at the beginning of the 20th century were gastrin, secretin and cholecystokinin. Now, we discuss about more than 30 different regulatory peptide hormones and more than 10 types of endocrine cells found in stomach, small and large intestines, such as incretins (glucose-dependent insulinotropic peptide and glucagon-like peptide-1), peptide YY, oxyntomodulin, ghrelin, obestatin and others. The role of gut hormones in energy homeostasis has been studied over the past 20 years. A great deal of researches in last years had shown the relationship between gastrointestinal hormones, obesity and type 2 diabetes, starting with incretin concept. Now, we have therapies based on gut hormones as targets, for patients with obesity, diabetes and non alcoholic fatty liver. Latest data present gut peptides as novel regulators of intestinal lipoprotein secretion and thus may have a great role in cardiovascular risk. Studies confirmed that gut hormones play a critical role in the regulation of metabolic, water and salt homeostasis and the development of hypertension and cardiovascular diseases. Recent investigations explained molecular mechanisms connecting gut hormones, insulin resistance and malignancies as well as inflammation processes in organism. Gut-brain axis and metabolism in polycystic ovary syndrome and it’s treatment has been a subject of polemics on recent endocrinology debates. Finally, there is a link between gut, adipose hormones and reproductive system and fertility in both sexes.

Biography:

Purnama Andriana has completed his Digestive Surgeon education at Hasan Sadikin Hospital, Padjadjaran University, Indonesia. He attended many digestive surgery courses and fellowships, including Laparoscopic Colorectal Fellowship at Singapore General Hospital (2009), Minimal Invasive Surgery training at Academisch Medisch Centrum Amsterdam (2012) and, Endoscopy Laparoscopy training at Queen Mary Hospital, Hong Kong (2013). He has become Digestive and General Surgery Consultant Staff at Padjadjaran University, Indonesia.

Abstract:

Perforated gastric ulcer is still the most common indication for emergency gastric surgery associated with high morbidity and mortality. Outcome might be improved by performing laparoscopy. The aim of this study was to evaluate the outcome of laparoscopy at Hasan Sadikin Hospital. The outcome laparoscopy approach and the associated morbidity and mortality, operation time, conversion rate and hospital stay were assessed and compared with laparotomy. There were 30 patients (24 males, 6 females) with perforated gastric ulcer with mean age 72.14, non-malignant cause was documented during January 2015-Desember 2015. Patients with Boey’s score 0-1, ulcer diameter less than 2 cm at anterior site, underwent laparoscopic gastric perforation closure with omental patch and the rest were laparotomy. Observation from 15 patients underwent laparoscopy with no conversion, resulted in a better outcome from duration of operation 60-90 minutes (mean 79.57) than laparotomy 60-120 minutes (mean 85.73). Postoperative pain was found better outcome in laparoscopy VAS 3.93, laparotomy 6.27. Early diet was implemented in laparoscopy patients according to ERAS from POD one. Length of hospital stay in laparoscopy group was five days and 10-12 days (mean 10.5) in laparotomy. Incidence of surgical site infection was found in five patients, leakage from perforated site in six patients and mortality in six patients, all of them were found in laparotomy group. Laparoscopy closure of perforated gastric ulcer is a safe therapeutic method with strict selection of patient criteria. Based on low rates of morbidity and mortality, we should encourage laparoscopy implementation in gastric ulcer perforation case.

Biography:

Ulrike Stein completed her Diploma degree at Martin-Luther University Halle, Germany and PhD at Humboldt University Berlin. For her Post-doctoral studies, she joined the laboratory of Dr. R H Shoemaker at National Cancer Institute/NIH Frederick as Feodor-Lynen-Fellow of Alexander von Humboldt foundation. She received her Habilitation at Charité Universitätsmedizin Berlin and appointed as Professor. She heads the research group of Translational Oncology of Solid Tumors at Experimental and Clinical Research Center, Charité Universitätsmedizin and Max-Delbrück-Center for Molecular Medicine in Berlin. Her research is focused on “Understanding and intervening in tumor progression and cancer metastasis formation”. She has published more than 130 papers in reputed journals. She is an Editorial Board Member and Reviewer of several journals. She received various national and international scientific awards.

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Biography:

Kondratskyy Y is Head of Esophageal and Gastric Tumors department at National Cancer Institute, Ukraine. He is the recipient of numerous awards for his expert research works in related fields. His research interests reflect in his wide range of publications in various national and international journals.

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Biography:

Baris Cankaya completed his Graduation at Ankara University Medical Faculty in 2000. He has been working as Anaesthesiology Specialist at Marmara University Training Hospital. He has attended academic meetings, nationally and internationally. His academic interest includes “Microcirculation, fluid therapy, resuscitation, patient safety and perioperative analgesia”. Some of his certificates are EPLS provider Berlin 2015, NLS provider Athens 2015 and MECOR Level I October 2014. He attended international workshops like ECMO workshop 2015, Leicester and Airway workshop, ICISA 2014, and Tel Aviv.

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Esam Elshimi is working at Menoufia University, Egypt. He is the recipient of numerous awards for his research works in related fields. His research interests reflect in his wide range of publications in various national and international journals.

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Esam Elshimi is working at Menoufia University, Egypt. He is the recipient of numerous awards for his research works in related fields. His research interests reflect in his wide range of publications in various national and international journals.

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Biography:

Hüseyin Sancar Bozkurt has completed his PhD at the age of 24 years from Trakya University and  Ä°nternal Medicine at the age of 30 from Çukurova University. He has completed gastroenterology education at the age of 33 years from Adana BaÅŸkent University. He has published multiple national and international papers.

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Statement of the Problem: Functional constipation (FC) and constipation-predominant irritable bowel syndrome (IBS-C) are a part of functional bowel disorders, and have a significant personal, healthcare, and social impact. Evaluation by anorectal manometry is essential in these cases for targeted treatment. Data on the anorectal manometric abnormalities in these patients is scarce. We aimed to study the anorectal manometric abnormalities in patients with functional constipation and constipation-predominant IBS in northern India. Methodology & Theoretical Orientation: A total of 114 consecutive patients with the history of chronic constipation who underwent anorectal manometry from January 2013 to December 2016 in a tertiary care institute were enrolled. Standard laboratory tests and colonoscopy were normal. Twenty-six healthy volunteers served as controls. Finding: The mean age was 46.7 years, 75.4% were males, and the median duration of constipation was 60 months. Sixty-two patients satisfied ROME IV criteria for functional constipation (FC) and 52 had Irritable bowel syndrome- constipation predominant (IBS-C). A comparison of the anorectal motor and sensory manometry parameters along with healthy controls is shown in the table. The resting anal pressure and the squeeze pressure were similar in all subgroups. Dyssynergic pattern of defecation was seen in significantly more patients in the FC group (p<0.001). The first sensation threshold was significantly higher among FC patients. The thresholds for the desire to defecate and maximum tolerable volume were significantly higher among FC and IBS-C patients compared to controls. Conclusions and significance: Dyssynergic pattern of defecation is seen in significantly more patients with FC compared to IBS-C. Patients with FC have marked the elevation of all sensory thresholds, while IBS-C patients have similar first sensation threshold with the elevated threshold for urge and maximum tolerance.

Abstract:

Omesh Goyal is working as an Associate Professor in Gastroenterology and Hepatology in a tertiary care institute in northern India. He has done a lot of research work on chronic hepatitis C and complications of cirrhosis. His other major interest includes functional bowel disorders and ano-rectal manometry. He is a part of the Indian working group on Chronic Constipation which will formulate guidelines for constipation in India under the leadership of Dr. Uday Ghoshal. His research work in has been acclaimed at international level. He won the National Scholar Award at UEG in Sweden and Best paper award in APICON in Hyderabad, India. He is working as an editor of the Journal of Gastrointestinal Infections and is an active member of various academic bodies.

Biography:

Shuaib Meghji is currently studying at University Hospital Southampton, UK.

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Biography:

Luis Hernandez-Higareda completed his Pre-grade in Biological Sciences at cyto-histopathology clinic and medicine at University of Guadalajara. He did his Post-graduation in Intensive Care, Clinical Epidemiology, and Master of Surgery at National Medical Center West, Mexican Social Security Institute (IMSS)-University of Guadalajara. He has undergone training in Gastrointestinal and Airway Endoscopy and Thoracoscopy at National Medical Center La Raza, IMSS, National Autonomous University of Mexico (UNAM). He completed courses in General Surgery and Endoscopic Ultrasound from XXI Century National Medical Center IMSS. He was trained in Surgery of Trauma at Trauma Hospital Lomas Verdes IMSS.

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Biography:

Gerard E Mullin is a board-certified Internist, Gastroenterologist and Nutritionist. He is an Associate Professor of Medicine and Director of Integrative GI Nutrition Services at Johns Hopkins Hospital. He is regarded as an authority in integrative gastroenterology. He teaches medical professionals at international conferences on “The role of nutrition and lifestyle and the gut microbiome in digestive health and weight control”. He is the author of several professional desk references and trade books including his latest book The Gut Balance Revolution: Boost Your Metabolism, Restore Your Inner Ecology, and Lose the Weight for Good!

Abstract:

The pathophysiology of obesity is still unknown but there is mounting evidence that the gut microbiome, intestinal permeability and systemic inflammation may play an important role in disease pathogenesis and possibly treatment. Alterations in diet have been shown to shift the gut microbiome's effects on metabolism and regulation of body weight. This session will provide a focused overview of the scientific literature regarding the potential role of gut microbiome as a therapeutic target of weight management. The lecture will first review the pathophysiology of obesity from a functional medicine perspective and discuss how a functional medicine evidence-based approach can achieve optimal weight management by three steps: Remove; restore and renew. Learning objectives are to: Discuss the influence of the gut microbiome on energy metabolism; understand how disruption of the gut microbiome can lead to obesity and; know how prebiotic and probiotic foods and supplements may influence weight by favorably altering the gut microbiome.

Biography:

Yoriaki Komeda studied Medicine at Kitasato University in 1974. In 2001, he started his formal training in Internal Medicine at Nara Medical University. He completed his training in Gastroenterology and became a Specialist in Japanese Society of Gastroenterology in 2011. He was a Clinical Research Fellow at St. Mark’s Hospital in London, UK in 2011 and Erasmus Medical Center in Rotterdam, Netherlands in 2012. He became a staff member in Gastroenterology department at Kindai University in 2014. His special interests are “Advanced interventional endoscopic techniques such as endoscopic treatment of early gastro-intestinal cancers”. He has published more than 15 papers in reputed journals.

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Biography:

Yoriaki Komeda studied Medicine at Kitasato University in 1974. In 2001, he started his formal training in Internal Medicine at Nara Medical University. He completed his training in Gastroenterology and became a Specialist in Japanese Society of Gastroenterology in 2011. He was a Clinical Research Fellow at St. Mark’s Hospital in London, UK in 2011 and Erasmus Medical Center in Rotterdam, Netherlands in 2012. He became a staff member in Gastroenterology department at Kindai University in 2014. His special interests are “Advanced interventional endoscopic techniques such as endoscopic treatment of early gastro-intestinal cancers”. He has published more than 15 papers in reputed journals.

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Biography:

Radosvet Gornev is a Head of General Surgery department at University Hospital Lozenentz Sofia, Bulgaria. He is an Assistant Professor of Surgery at Sofia University “St. Kliment Ohridski”. He works at UH Lozenetz Sofia, Bulgaria since 2008. He has experience in “General and colorectal surgery, research, evaluation, teaching and administration both in hospital and education institutions”. From 2008, he is a part of liver transplant program at UH Lozenez, Bulgaria. He has passed a lot of practical modules in different European countries and did research fellowship at Clivland Clinic, USA during 2003.

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Biography:

Chung-Hung Yeh has completed his Medical Degree at Taipei Medical University. After, he completed General Surgical training in 1995; he completed his Colorectal Surgical training at Chang-Gang Memorial Hospital (CGMH), and became the Director of Department of Colorectal Surgery at Chai-Yi CGMH from 2001 to 2009. He has published more than 25 papers in reputed journals and was a Senior Lecturer at Chang-Gang Medical School. He serves as Deputy Director of Surgical department at St. Martin De Porres Hospital since 2013.

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M Iqbal Rivai is currently working in General Hospital of Dr. M. Djamil Padang, Indonesia. He has worked for more than 10 years in the related field and gained a plethora of knowledge in related field. His international experience includes various programs, contributions to reputed journals and participation in different international conferences in diverse fields of study.

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Gastrointestinal endoscopy is a medical instrument for examining the interior canal of digestive tract. The use of the tool has been reported as early as 1822 by William Beaumont. Modern endoscopy as what we now daily use, has been invented in 1983. Various digestive diseases that previously must be diagnosed and treated by invasive method can now take the advantage of flexible endoscopy with ease of procedure and excellent diagnostic accuracy, and can even achieve therapeutic results without open surgery. This presentation will show a brief history of GI endoscopy, listing indications of endoscopy, and more importantly will show recent advances in the field of surgical endoscopy. Clinical results, success rate as well as its complications will be discussed.

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Wai-Kay Seto completed his Medical degree in 2003 and Doctor of Medicine in 2012. He is currently a Clinical Associate Professor in Department of Medicine at University of Hong Kong. He is also a fellow in Gastroenterology and Hepatology and Consultant of Medicine at University of Hong Kong-Shenzhen Hospital, Shenzhen, China. He has published more than 100 peer-reviewed articles in high-impact peer-reviewed journals, including first-authored articles in Journal of Clinical Oncology, Gut, Hepatology, Journal of Hepatology and American Journal of Gastroenterology. He has been awarded numerous research awards by Hong Kong College of Physicians.

Abstract:

Liver biopsy has long been an imperfect gold standard for the assessment of liver fibrosis. While liver biopsy is still widely considered in the disease assessment of viral hepatitis and non-alcoholic steatohepatitis, its invasive nature means it is seldom used to assess treatment response in stable and asymptomatic patients. Non-invasive methods of liver fibrosis are gradually emerging. Serum-based markers e.g. enhanced liver fibrosis score have been shown to correlate strongly with actual histology for multiple chronic liver diseases. Another method of assessing is liver stiffness measurements via transient elastography, a non-invasive ultrasound-based method that is easily performed with high reproducibility. Liver stiffness measurements have been well-validated in chronic hepatitis B, chronic hepatitis C and non-alcoholic fatty liver disease. In addition, liver stiffness measurements have been shown to have prognostic value on the development of cirrhotic complications, hepatocellular carcinoma and all-cause mortality. Evidence on the role of liver stiffness measurement in the clinical monitoring of treatment response is also emerging. Transient elastography also allows the measurement of controlled attenuation parameter, a quantitative marker of steatosis. Transient elastography is now recommended by multiple international guidelines as an assessment tool for chronic liver diseases. There are also other methods of liver fibrosis assessment, e.g. magnetic resonance imaging-based methods that are currently in development.

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Biography:

Sebnem Calik has completed her MD at Trakya University and Post-doctoral studies at Ege University, Medical Faculty of Infectious Diseases and Clinical Microbiology Clinic. She is a Specialist at Saglik Bilimleri University, Ä°zmir Bozyaka Education and Research Hospital, Infectious Diseases Department. She is interested in Febrile Neutropenia, Bloodstream Infection, Nosocomial Infection and Fungal Infection. She has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

Colonoscopy is the endoscopic examination of the large bowel and the distal part of the small bowel with a camera on a flexible tube passed through the anus. It can provide a visual diagnosis (e.g. ulceration, polyps) and grants the opportunity for biopsy or removal of suspected colorectal cancer lesions. Complications of colonoscopy are rare. These complications are perforation, bleeding, anaesthesia related bowel preparation and infection. The rate of infection was found as 1/1.8 million. The risk of infection development differs depending on gastrointestinal system region in which the endoscopic procedure is performed, and on type of procedure, and on patient’s underlying disease. The incidence of bacteremia after colonoscopy whether with or without biopsy and polypectomy varies between 0 and 25%. Bacteremia developing in immuno competent patients during or after colonoscopy is generally transient or asymptomatic. The incidence of transient bacteremia in flexible endoscopes varies between 0 and 1%. Colonoscopy related infections are of two forms: 1) Endogenous infection: The spread of patients own microbial flora in gastrointestinal system to other organs or prosthesis via the bloodstream during colonoscopy. Endoscopic procedures most often result in endogenous infections (i.e., infections resulting from the patient's own microbial flora), and E. coli, Klebsiella spp., Enterobacter spp., and Enterococci are the species most frequently isolated. 2) Exogenous infections: The spread of microorganisms from one patient to other patient by a contaminated endoscope (opportunistic pathogens such as bacteria, HBV, HCV, fungi, parasites etc.). The important risk factors of exogenous infections in colonoscopy are the number of microorganisms present inside the endoscope or biofilm production, invasive procedure which is resulting tissue damage, immuno compromised status of the patients (malignancy, solid organ transplantations, immunosuppressive treatment, human immunodeficiency virus, etc.) and presence of infectious focus during colonoscopy. Such infections are preventable with strict adherence to accepted reprocessing guidelines.

Biography:

Abstract:

Biography:

Liana Kurmanseitova completed her PhD in Medicine at Moscow State University of Medicine and Dentistry. She is a Professional Surgeon in the field of Intervention Surgery and currently employed at the clinic of endoscopic and minimally invasive surgery under Stavropol State Medical University. She has a vast experience in the “Medical treatment of patients with obstruction jaundice”. She has participated in more than 15 international conferences and performed two on-line workshops for the wide audience.

Abstract:

Biography:

Bulent Calik has completed his MD at Cukurova University, Turkey and Post-doctoral studies at Saglik Bilimleri University, Tepecik Education and Research Hospital in General Surgery department. He is the Chief Assistant at Saglik Bilimleri University Ä°zmir Tepecik Education and Research Hospital. He is interested in Oncological Surgery, Robotic Surgery, Laparoscopic Surgery and Colorectal Surgery. He has published more than 20 papers in reputed journals and has been serving as an Editorial Board Member of repute.

Abstract:

This study is a review of the literature related to acute pancreatitis in Turkey. In order to find the published reports on this subject, national database (Tübitak Ulakbim Turkish Medical Literature database, http://www.turkishmedline.com, and two international databases [Index Medicus and Science Citation Index (SCI)-expanded] were searched. Key words for national database were acute pancreatitis, akut pankreatit and the key words for index medicus and SCI-e were acute pancreatitis and Turkey. More than three published case reports were included. Data for 959 patients with acute pancreatitis were obtained from 13 reports. Of the patients, 381 (40%) were males and 578 (60%) females. Their ages ranged from 16 to 107 years. Etiological factors were biliary in 674 (70%), alcohol in 70 (7%), hyperlipidemia in 40 (4%), diuretic usage in 12 (1%) and trauma in 11 (1%). 152 of all patients (16%) etiology were non-specific. Mortality was seen in 128 cases (13%). 265 (28%) patients had necrotizing pancreatitis. Of these necrosis rate is less than 30% in 76 (29%), 30-50% in 70 (26%), 50% in 107 (40%) patients. 12 patients (5%) had extra-pancreatic necrosis. 49 patients (5%) had abscesses in abdomen, 35 patients (4%) had pancreatic fistula, 16 patients (2%) had pseudocyst, 12 patients (1%) had bleeding into the abdomen, 10 patients (1%) had bile fistula, 10 patients (1%) had enterocutaneous fistula and seven patients (1%) had pancreatic abscesses. 12 patients (1%) had endocrine pancreatic insufficiency, three patients (0.3%) had exocrine pancreatic insufficiency. 59 of all patients (6%) developed multiple organ failure. Relaparotomy was performed in 19 patients (7%) with necrotic pancreatitis. Despite continuing technological advances in diagnosis and treatment, acute pancreatitis remains a disease with high morbidity and mortality.

Biography:

Since laparoscopic cholecystectomy was done for the first time by Philippe Mouret (France, 1987), the development of minimally invasive surgery in the hepatobiliary system has been progressing, followed by Berci, Phillips (USA, 1991) who has done laparoscopic common bile duct exploration (LCBDE) successfully later on. Abnormal intraoperative cholangiogram, unsuccessful attempts at endoscopic stone extraction for large/occluding stones, and intrahepatic stones are the indications for a LCBDE. While contraindications for the procedure, such as inability of the surgeons to perform the necessary maneuvers, absent of indication, instability of the patient, local condition in the porta hepatic made exploration hazardous, diameter of cystic duct less than 4 mm (transcystic procedure) or diameter common bile duct (CBD) less than 6 mm (transcholedochal). Three major options in management of cholelithiasis with CBD stone were open cholecystectomy with CBD exploration, endoscopic sphincterotomy and stone extraction followed by laparoscopic cholecystectomy (two stages) or laparoscopic cholecystectomy and laparoscopic CBD exploration done in one stage. Choice of the treatment was based on patient safety consideration, time efficiency, and cost effectiveness. Surgeons’ competency becomes an important role to determine a successful LCBDE. Availability and preparedness of instruments/equipment included Endoscopic Retrograde Cholangiopancreatography (ERCP) facilities are also the crucial supporting factors. LCBDE in Jakarta was done from August 2004 to July 2016 with 44 cases. Mean age of the patients were 52 years. Mean operation time was approximately 3.5 hours, with mean hospital stay about 5.5 days. Conversion of the operation was caused by impacted stones, massive adhesion (anatomical reason) or instrument failures. Several complication or morbidity after the surgery included retained stone, subphrenic abscess, T-tube insertion leakage, respiratory tract infection, urinary tract infection and superficial wound infection. Recently, the LCBDE become an important alternative choice in the treatment of CBD stone, especially in the failure of ERCP/endoscopic stone extraction. LCBDE as a minimally invasive procedure has the advantages with high success rate, low morbidity, and mortality rate and faster post-operative period recovery. However, we still need more training and learning curve.

Abstract:

Errawan R Wiradisuria is the President of Indonesian Society of Endo-Laparoscopic Surgeons and Chairman of Advance Laparoscopic Surgery courses (Asia-Pacific). He has published numerous papers in reputed journals and has been serving as an Editorial Board Member of repute.

Biography:

Abstract: