Scientific Program

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Scientific Program Day 1
Scientific Program Day 2

Day 2 :

Keynote Forum

David H Van Thiel

Advanced Liver and Gastrointestinal Disease Center, USA

Keynote: Subsequent clinical exocrine pancreatic insufficiency, a disease requiring recognition and therapy

Time : 09:00-09:40

Conference Series Gastro 2017 International Conference Keynote Speaker David H Van Thiel photo
Biography:

David Van Thiel is a Gastroenterologist in Berwyn, Illinois. He is affiliated with multiple hospitals in the area, including Rush Oak Park Hospital and Rush University Medical Center. He completed his Medical degree from David Geffen School of Medicine at UCLA and has been in practice for 39 years. He is one of the 21 doctors at Rush Oak Park Hospital and one of 25 doctors at Rush University Medical Center who has specialization in Gastroenterology. He completed his Graduation from University of California at Los Angeles. He has obtained board certification from the member board for Internal Medicine and Hepatology.

 

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

  • Hepatobiliary | IBD/ Endoscopy
Location: Olimpica 2
Speaker

Chair

David H Van Thiel

Advanced Liver and Gastrointestinal Disease Center, USA

Speaker

Co-Chair

Errawan R Wiradisuria

Indonesian Society of Endo-Laparoscopic Surgeons (ISES), Indonesia

Session Introduction

Luis A hernandez Higareda

Hospital of Traumatology "Lomas Verdes". (HTOLV). IMSS, Mexcico

Title: Current criteria for colostomy in trauma

Time : 14:00-14:20

Speaker
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.

Abstract:

Background & Aim: There is no consensus in Mexico on the criteria for colostomy in trauma. We have reported in the world literature reports since 1990 recommending primary closure in colon lesions up to 96%. This generalized primary closure in our country is not feasible. The surgeon must decide between performing an anastomosis or a colostomy. We analyzed the main criteria for colostomy in severe polytraumatized patients with colon injury.
 
Material & Methods: In a prospective cohort of polytraumatized patients with colostomy, the main criteria for colostomy in trauma in three years were analyzed.
 
Results: In the first three years, 270 laparotomies were performed per year, with a total of 70 colon lesions, 65 per perforation (excluding two intraoperative deaths). Of the 63 patients, primary closure was performed in 29 (46%): Colostomy was performed in 34 patients (54%). Criteria found for colostomy: Location of the lesion in the left colon (used as a criterion for the left localization of the colon) in 50%, PATI (Penetrating Abdominal Trauma Index) in 50%, ISS (Injury Severity Score) in 47%, flint (criteria of flint) in 82% and stone and fabian (criteria by stone and fabian) by 91%. The latter always took into account the need for resection of the colon and significant loss of the abdominal wall. Of the remaining five criteria of stone and fabian were found: At preoperative pressure less than 60 to 80 mm Hg in nine (26%), to intraperitoneal hemorrhage>1000 cc in 11 (32%), to more than two intraperitoneal organs lesions in 19 (56%), major intraperitoneal dissemination of feces in 13 (38%) and with more than 8 hours of injury at the time of surgery in two (6%).
 
Conclusion: According to the trend shown by the results of this cohort, the criteria most taken into account in this hospital are those of stone and fabian. These criteria are considered in 100% to the patient that requires colon resection and those with significant loss of the abdominal wall.
 

Gerard E Mullin

Johns Hopkins Hospital, USA

Title: The Gut Balance Revolution

Time : 16:40-17:00

Speaker
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.

Yoriaki Komeda

Kindai University, Japan

Title: Therapeutic strategies for four subtypes of laterally spreading tumors (LSTs) of the colorectum

Time : 16:20-16:40

Speaker
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.

Abstract:

Background & Aim: Laterally spreading tumors (LSTs) are generally defined as superficial lesions≧10 mm in diameter that extend laterally rather than vertically along the colonic wall. They are divided into granular type and non-granular type; the former is further divided into homogenous (LST-G(H)) and mixed nodular (LST-G(M)) and the latter is subdivided into flat-elevated (LST-NG(F)) and pseudo-depressed(LST-NG(P)). It seems that the biological behavior is different among these four subtypes. The goal of this study is to clarify the endoscopic and pathological characteristics of each subtype and establish therapeutic strategies for LSTs based on the sub-classification.
 
Methods: We investigated consecutive 380 lesions of LST in 349 patients which were treated in our hospital between April 2010 and June 2014. The location, maximum diameter, invasive rate and the surface pit pattern were evaluated.
 
Results: The LST patients included 186 males and 163 females and the average age was 68.3 year old. The therapeutic method was EMR in 158 (piecemeal EMR: 41), ESD in 207 and surgery in 15. The most affected site by each subtype was the cecum LST-G(H), the rectum in LST-G(M), and transverse colon in LST-NG subtypes. The mean size was 29.5 mm in LST-G(H), 38.1 mm in LST-G(M), 20.5 mm in LST-NG(F), and 24.2 mm in LST-NG(P). The invasive rate in each subtype was 0.8%, 18.5%, 5.3%, and 15.9%, respectively. It seems that piecemeal resection is acceptable for LST-G(H) as the possibility of its being an invasive cancer is extremely low. Mixed granular type can also be treated with a snare provided that the nodular part cannot cut as piecemeal. It is sometimes difficult to predict in which part the flat-elevated type is invading. In such cases, the pit pattern observation is useful; when the pit pattern is type III L or IV, the corresponding part is not invasive but the area with type V pit pattern should not cut into pieces as this part is supposed to be invasive. 
 
Conclusion: The biological behavior is difficult among the four subtypes of LSTs. We should predict the histology precisely and determine the therapeutic strategy based on the subtype and also the pit pattern of the lesion surface.
 

Yoriaki Komeda

Kindai University, Japan

Title: Therapeutic strategies for four subtypes of laterally spreading tumors (LSTs) of the colorectum
Speaker
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.

Abstract:

Background & Aim: Laterally spreading tumors (LSTs) are generally defined as superficial lesions≧10 mm in diameter that extend laterally rather than vertically along the colonic wall. They are divided into granular type and non-granular type; the former is further divided into homogenous (LST-G(H)) and mixed nodular (LST-G(M)) and the latter is subdivided into flat-elevated (LST-NG(F)) and pseudo-depressed(LST-NG(P)). It seems that the biological behavior is different among these four subtypes. The goal of this study is to clarify the endoscopic and pathological characteristics of each subtype and establish therapeutic strategies for LSTs based on the sub-classification.
 
Methods: We investigated consecutive 380 lesions of LST in 349 patients which were treated in our hospital between April 2010 and June 2014. The location, maximum diameter, invasive rate and the surface pit pattern were evaluated.
 
Results: The LST patients included 186 males and 163 females and the average age was 68.3 year old. The therapeutic method was EMR in 158 (piecemeal EMR: 41), ESD in 207 and surgery in 15. The most affected site by each subtype was the cecum LST-G(H), the rectum in LST-G(M), and transverse colon in LST-NG subtypes. The mean size was 29.5 mm in LST-G(H), 38.1 mm in LST-G(M), 20.5 mm in LST-NG(F), and 24.2 mm in LST-NG(P). The invasive rate in each subtype was 0.8%, 18.5%, 5.3%, and 15.9%, respectively. It seems that piecemeal resection is acceptable for LST-G(H) as the possibility of its being an invasive cancer is extremely low. Mixed granular type can also be treated with a snare provided that the nodular part cannot cut as piecemeal. It is sometimes difficult to predict in which part the flat-elevated type is invading. In such cases, the pit pattern observation is useful; when the pit pattern is type III L or IV, the corresponding part is not invasive but the area with type V pit pattern should not cut into pieces as this part is supposed to be invasive. 
 
Conclusion: The biological behavior is difficult among the four subtypes of LSTs. We should predict the histology precisely and determine the therapeutic strategy based on the subtype and also the pit pattern of the lesion surface.
 

Radosvet Gornev

University Hospital Lozenentz Sofia, Bulgaria

Title: Colorectal cancer: Current issues in Bulgaria

Time : 16:00-16:20

Speaker
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.

Abstract:

Statement of the Problem: According to National Cancer Register, colorectal cancer is the third most commonly diagnosed cancer and the second leading cause of cancer death in Bulgaria. In 2013, new colorectal cancer patients are 2676 and all data shows increase of the number for the next years. Due to leak screening program and poor prophylaxis most of the cases (40%) are present in an advance stage. Five years survival rates for stage I and II are 86% compare to only 8% in stage IV patient. 
 
Methodology & Theoretical Orientation: Review of the literature and single-center study of 405 patients with colorectal cancer. 
 
Findings: The aim of the study is to analyze the distribution of patients according to the disease stage. Most of the patients are diagnose preoperative as II a stage, but in a pathological examination the contribution between the stage II, III, IV is approximately same. 75.5% of all patients have one or more additional diseases that increases the risk of intra and postoperative complications 
 
Conclusion & Significance: The poor prophylaxis and ineffective screening program leads to advance stage disease at time of diagnosis. Comorbidity, often with bad control in combination with advanced stage at the time of surgery is the main reason for lower survival rates in Bulgaria. This conclusion is proven by 10.4% less relative 5 years survival rate compare to all Europe.
 

Chung-Hung Yeh

St. Martin De Porres Hospital, Taiwan

Title: Update of stapled anorectal surgery

Time : 15:40-16:00

Speaker
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.

Abstract:

The surgical stapling technique was pioneered by a Hungarian surgeon, Dr. Humer Hultl, known as the “father of surgical stapling”. In the early 1900s, many of the basic principles of mechanical stapling began to emerge. After one century's development, all kinds of devices were invented, including linear staplers, linear cutters, and circular staplers. The staplers also make minimally invasive surgery possible. There are plenty of endoscopic staplers were designed, and these were utilized in chest surgery, gastric surgery, bowel surgery, and many other surgical procedures. The surgical staplers were also used in anorectal surgery. The circular staplers have been used for low and very low bowel anastomosis to avoid permanent colostomy for decades. Stapled transanal mucosectomy, firstly aims to treat rectal internal mucosal prolapse and obstructed defecation, and was later proposed by Dr. Antonio Longo for the treatment of hemorrhoids in 1993. Subsequently called stapled hemorrhoidopexy or procedure for prolapsed hemorrhoids (PPH), the technique gained a wide popularity due to the low postoperative pain. In 2005, the practice parameters of the American Society of Colon and Rectal commended: Stapled hemorrhoidopexy is a new alternative available for individuals with significant hemorrhoidal prolapse. Then, also proposed by Dr. Longo, a rectal wall resection with a circular stapler was the basis for the development of the stapled transanal rectal resection (STARR) procedure. This procedure consists of a double transanal rectal resection and is aimed at correcting the anatomical anomaly of the rectum in patients with rectocele and/or rectal intussusception causing obstructed defecation. Although some exceptionally rare but potentially devastating complications include anovaginal fistula, substantial hemorrhage, fistula, retroperitoneal sepsis, and rectal perforations have been reported after stapled anorectal surgery, the documented adverse events scattered and presented as case-report. When the procedures of PPH and STARR were accepted, more and more stapled anorectal rectal procedures have been presented, and the efficacy and safety of these new procedures will need further monitoring. 
 

M Iqbal Rivai

Andalas University, Indonesia

Title: Laparoscopic Colorectal Surgery

Time : 15:20-15:40

Speaker
Biography:

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.

Abstract:

Traditionally, operation on the colon and rectum required a large abdominal and /or pelvic incision, which often required a lengthy recovery. New instrumentation and techniques allow the surgeon to perform the procedure through several small incision, what we now refer to as “ minimally invasive “, “ laparoscopic “, or “ laparoscopic-assisted “ colorectal surgery.
 
Minimal invasive surgery can be successfully performed for a variety of common benign and rectal conditions including diverticulitis, colon polyps, inflammatory bowel disease ( Crohn’s Disease and Ulcerative Colitis ), rectal prolapse and malignancy. It ca be used to remove the entire colon and rectum or just portion, or segment, of the colon. Minimally invasive techniques can be used to create an ostomy. They may be either colostomy or an ileostomy. Also, minimally invasive techniques can be used to reconnect the intestine from a temporary ostomy. There are very few traditional abdominal colon and rectal procedure that cannot be performed in a minimally invasive manner. 
 
Laparoscopic colorectal surgery refers to a technique where the surgeon makes several small incision, instead of a single large incision. For most colon and rectal operation, 3 – 5 incisions are needed. Small tubes, called “ trocars “, are placed through this incision and into the abdomen. Carbon dioxide gas is used to inflate the abdomen in order to give the surgeon room to work. This allows to the surgeon to use a camera attached to a telescope to watch a magnified view of the inside of the abdomen on operating room monitors. 
 
Laparoscopic colorectal surgery is a significantly more challenging operation as it frequently involves often more than one abdominal quadrant, identification and transaction of vascular structures, mobilization and resection of the bowel, retrieval of the surgical specimen and performing an anastomosis. The greater complexity of laparoscopic colectomy has been associated with longer operative times and long learning curve. Ileocolic resection, segmental colectomy or anterior resection of the rectum for cancer, segmental colectomy for benign disease and rectopexy can perform laparoscopically. 
 
Results are different for each procedure and each patient, some common advantages of minimally invasive colorectal surgery are the shorter hospital stay, shorter recovery time, less pain from the incisions, faster return to normal diet, faster return to work or normal activity, better cosmetic healing. Many patients qualify for laparoscopic or minimally invasive surgery. However, some conditions may decrease a patient”s eligibility, such as previous abdominal surgery, cancer ( in some situation ), obesity, variations in anatomy or advanced heart, lung, or kidney disease. 
In Indonesia, laparoscopic colorectal surgery has been frequently used. Especially in my area West Sumatra, 3-5 patients per day underwent laparoscopic appendicectomy and 5-7 patients each month with colonic malignancy performed laparoscopic approaches such as laparoscopic hemicolectomy, low anterior resection, and surgical redundant sigmoid. The choice of therapy affected by many factors. On a few occasions, an operation may be started laparoscopically and subsequently converted to an open operation due to technical factors such as bleeding or inability to clearly see and recognize the area to be operated on. 
 
Since 2011 has been nearly 300 cases of colorectal malignancy that do minimally invasive surgical therapy. At 3 years, the locoregional recurrence rate was 5.0% in the two groups. Disease – free survival rates were 74.8 % in the laparoscopic surgery group and 70.8% in the open surgery group. Overall survival rates were 86.7% in the laparoscopic surgery group and 83.6% in the open-surgery group.
 

Reno Rudiman

Padjadjaran University, Indonesia

Title: Recent Advances in Surgical Endoscopy

Time : 14:40-15:00

Speaker
Biography:

Reno Rudiman is a Digestive Surgeon at Hasan Sadikin Hospital in Bandung, Indonesia. He completed his Master’s degree at University of Aberdeen, UK and PhD at Universitas Padjadjaran, Indonesia. He also completed his training in General Surgery and Digestive Surgery at Universitas Padjadjaran. He has published numerous national as well as international publications on surgery. He has a special interest in Minimal Invasive Surgery. He was among the first surgeons in Indonesia licensed to perform robotic surgery. He is a national faculty member of the Indonesian Society of Endolaparoscopic Surgery, and regularly teaches Endolaparoscopy.
 

Abstract:

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.

Alexander Natroshvili

I.M. Sechenov First Moscow State Medical University, Russia

Title: First results of modified diagnostic scale use for patients with possible appendicitics

Time : 14:20-14:40

Speaker
Biography:

Alexander Natroshvili has completed his PhD at I.M. Sechenov First Moscow State Medical University. He is an Assistant Professor at I.M. Sechenov First Moscow State Medical University, Head of Department at University Hospital. He has published more than 25 papers in reputed journals.
 

Abstract:

Background: Acute appendicitis is still a diagnostic challenge. Different scoring systems are designed to aid in the diagnosis of this common disease, including Alvarado score, recent appendicitis inflammatory response score, etc. Ultrasonography is widely used imaging modality that increases diagnostic accuracy, but false negative result rate is relatively high, leading to increased risk of misdiagnose acute appendicitis. Limitations of this diagnostic method led us to development of new diagnostic scale.
 
Materials & Methods: Retrospective study of 231 proved acute appendicitis cases was performed to detect the most sensitive and specific clinical signs and lab parameters. Using this data and statistical analysis, we developed diagnostic scoring system, that included clinical signs, blood test and ultrasonography results. Prospective study included 43 consecutive patients with suspected acute appendicitis. Physical examination, ultrasound, laparoscopy and appendectomy were performed by the same surgeon. Diagnosis of appendicitis was confirmed or excluded histologically in all specimens. 
 
Results: Our scoring system allowed to diagnose appendicitis in 27 of 28 histologically proven cases, to exclude it correctly in 14 of 15 cases. According to protocol, four patients with equivocal diagnostic scale result underwent laparoscopy that diagnosed appendicitis in one case (false-negative result). Histology didn’t confirm acute appendicitis in one case (false-positive result). Diagnostic scale sensitivity was 96.4%, specificity 93.3%, accuracy 95.3%, positive predictive value 96.4%, negative predictive value 93.3%. Negative appendectomy rate was 3.7%.
 
Conclusion: First results showed that developed scoring system is highly sensitive and specific in detecting acute appendicitis. It could aid in selecting patients who require immediate surgery or those who require further evaluation. Proper prospective randomized trial evaluating the effect of such scoring system must be performed before recommending this scoring system for wide use. 
 

Wai-Kay Seto

The University of Hong Kong, Hong Kong

Title: Non-invasive assessment of liver fibrosis and steatosis

Time : 09:40-10:00

Speaker
Biography:

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.

Kenro Kawada

Tokyo Medical and Dental University, Japan

Title: Observation of the pharynx to the cervical esophagus using transnasal endoscopy with image enhanced endoscopy

Time : 12:40-13:00

Speaker
Biography:

Abstract:

Alexander Surya Agung

Bhayangkara Police Hospital, Indonesia

Title: Laparoscopic Inguinal Hernia Repair TAPP under Regional Aneshesia: Clinical Experience

Time : 12:20-12:40

Speaker
Biography:

Alexander Surya Agung is a Head of Surgery department at Bhayangkara Police Hospital, Surabaya, Indonesia. He completed his Medical Doctor at University of Airlangga, Surabaya-Indonesia and; General Surgeon at University of Airlangga, Surabaya-Indonesia. He is interested in Minimally Invasive Surgery and, attended courses at Singapore, India, Taiwan and Philippines. He is a member of Indonesian Endo-Laparoscopic Society, Indonesian Hernia Society, Endoscopic and Laparoscopic Surgeons of Asia, Asia Pacific Hernia Society and European Association for Endoscopic Surgery.
 

Abstract:

Objective: Laparoscopic inguinal hernia repair transabdominal preperitoneal (TAPP) is conventionally done by general anesthesia. This procedure can be performed by regional anesthesia. We present four years of experiences (Jan 2012–Dec 2015) using regional anesthesia for laparoscopic inguinal hernia repair TAPP to assess the feasibility and safety of this procedure.
 
Methods: Between Jan, 2012 to Dec, 2015, 93 patients with inguinal hernias, ASA I & II, underwent TAPP repair under loco regional anesthesia [spinal/peridural/combined, sedation (Midazolam) and analgesia (morphine/fentanyl)], spinal anesthesia level VL III–IV, Spinocan 29G with block target VTh IV-V using a low pressure CO2 (10–12 mm Hg) pneumoperitoneum. Strangulated and obstructed patients were excluded but irreducible were included. All defects covered by low weight plain mesh 10x15 cm and fixated by secure strap. Patients were followed up over one year period.
 
Results: There was neither conversion from spinal anesthesia to general anesthesia nor to opened surgery. Age: 17–53 years (average: 32 years), sex: male 88 patients, female five patients. Defects: unilateral 88, bilateral five, six patients with recurrent case. Operating time: 30–135 minutes (average: 60 minutes). Average hospital stays one, five days (one–two days). Two patients complained of shoulder pain, two patients suffered bradycardia and one hypotension intra operatively. There were no postural headache, PONV (post-operative nausea and vomiting) and urinary retention found.
 
Conclusion: TAPP repair is feasible and safe under regional anesthesia. Further studies are required to validate this technique.
 

Sebnem Calik

Saglik Bilimleri University Izmir Bozyaka, Turkey

Title: Colonoscopy and Infectious Disease

Time : 12:00-12:20

Speaker
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.

Cheng Zhang

The Ohio State University, USA

Title: Ulcerative Colitis (UC) - Associated Colorectal Cancer (CRC) Patients Who Receives Colorectal Surgery More Likely Receive Blood Transfusion and Parental Nutrition Than Crohn’s Disease (CD) - Associated CRC Patients - A Propensity Match Study

Time : 11:40-12:00

Speaker
Biography:

Abstract:

Introduction & Aim: The health care resource utilization of inflammatory bowel disease (IBD)-associated CRC patients who undergo colorectal surgery is unknown. Aim of this study was to compare the health care resource utilization, particularly the requirements of blood transfusion and parental nutrition, between ulcerative colitis (UC)-associated colorectal cancer (CRC) and CD-associated CRC who receives colorectal surgery. 
 
Methods: This was a cross-sectional study using data from the Nationwide Inpatient Sample. UC- or Crohn’s disease (CD)-related and CRC-related hospitalizations that underwent colorectal surgery between 2008 and 2012 were identified using appropriate ICD-9-CM codes. Exclusion criteria included: Age<18 years; carrying discharge diagnosis of both ulcerative colitis and Crohn’s disease (CD); CD with small intestine involvement only and; patients with missing data among the variables of interest. The health care resource utilization, including receiving blood product and parental nutrition was compared between UC-associated and CD-associated CRC patients who underwent colorectal surgery. Statistical analysis: A propensity match study was used to compare the outcomes between these two groups.
 
Results: There were a total of 197 pairs of patients in each UC-associated CRC and CD-associated CRC group and they matched well with respect to demographics, comorbidities, and institutional characteristics. We performed McNemar’s tests for categorical variables in the matched sample. UC-associated CRC patients who receive colorectal surgery more likely receive blood transfusion (p=0.0039) and parental nutrition (p=0.0203) when compared with CD-associated CRC patients (Table 1). In addition, the CRC location is also different between UC- and CD-associated CRC (p=0.0006). More CD-associated CRC patients have right-sided colon lesions. CD-associated CRC patients more likely received partial colectomy than UC-associated CRC patients (p<0.0001) (Table 2). 
 
Discussion: Inflammatory bowel disease (IBD) is associated with an increased risk of CRC. In contrast to sporadic CRC, IBD-associated CRC is frequently diagnosed at a more advanced stage and tumors are often multiple and poorly differentiated. Because UC and CD have different pathophysiology, subsequently, the phenotype and response to treatments including colorectal surgery between UC- and CD-associated CRC would be different. Our study is the first to examine the health care resource utilization in UC- and CD-associated CRC who receives colorectal surgery. Colorectal surgery in UC-associated CRC patients has been associated with higher health care resource utilization, including blood transfusion and parental nutrition, when compared with CD-associated CRC. In addition, the location and type of colorectal surgery are also different between these two groups. This study suggested that the surgical treatment for UC- and CD-associated CRC is different and therefore, care of IBD-associated CRC around colorectal surgery should be treated differently between UC and CD patients.
 

Liana Kurmanseitova

Stavropol State Medical University, Russia

Title: Complications of Antegradny Access at the Decompression of Bilious Channels at Patients with Mechanical Jaundice and Ways of their Treatment

Time : 11:00-11:20

Speaker
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:

Introduction: Percutaneous transhepatic drainage of the bile duct and its tributaries is performed for the patients who have the unresectable tumor of the hepatoduodenal area with obstruction of biliary system; only when it is not possible to drain by endoscopy due to dramatic pathological changes in the region or low-performance status of the patient. This procedure improves the quality of life and overall survival without changing disease prognosis.
 
Aim: The aim of the study is the efficacy and safety assessment of percutaneous techniques installation of biliary drainage systems, and differentiate possible complications and there treatment.
 
Method: From 2014 to 2015, the clinic endoscopic and minimally invasive surgery at Stavropol State Medical University (StSMU) had 112 inpatients with obstructive jaundice. All patients underwent percutaneous transhepatic drainage of the bile duct and its tributaries. Total 128 operations were done. The average patient age was 65.5 years; mean bilirubin level at admission was 253.
 
Results: We performed 128 operations on patients. In all cases, the biliary system was drained effectively. In 41.4% mounted external drainage, 32% of the external-internal drainage, 4% drainage bilobar, 6.2% bile duct stent, 3.1% “rendez-vous” passage technique of benign strictures of the common bile duct. In 1.5% of cases, after the drainage of the biliary ducts, hemobilia occurred that was resolved conservatively by the change of drainage and washing. In 13.2% of cases of cholangitis after drainage, in all cases, they were treated conservatively. Allergic reaction was observed to the anesthetic 2.3% (three patients). Leakage of bile into the abdominal cavity was seen because of drainage migration in 1.5% (two patients). The lethal outcome of 0.5% (within seven days of observation) and the duration of hospitalization were three days for the early ambulated patients- fast track.
 
Conclusion: Percutaneous transhepatic drainage of the bile duct and its tributaries is an important alternative to endoscopic drainage. This intervention is shown to extend the lives of patients with malignant stricture with a low level of survival. Treatment of postoperative complications, the antegrade way of interventions in most cases doesn't demand performance of open operations.
 

Bulent Calik

University Izmir Tepecik Education and Research Hospital, Turkey

Title: Acute pancreatitis cases in Turkey: A review of the literature between 1980 and 2016

Time : 10:40-11:00

Speaker
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.

Errawan R Wiradisuria

Indonesian Society of Endo-Laparoscopic Surgeons (ISES), Indonesia

Title: Recent Advances in Cbd Stones Management, Laparoscopic Common Bile Duct Exploration (LCBDE)

Time : 10:20-10:40

Speaker
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.

Esam Elshimi

National Liver Institute, Menoufiya University, Egypt

Title: Current safety and feasibility of ERCP in management of early and late post liver transplant biliary complications

Time : 10:00-10:20

Speaker
Biography:

Esam Elshimi is working at Menoufia University, Egypt. 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.

Abstract:

Background & Aim: Biliary complications after living donor liver transplantation (LDLT) represent the most challengeable burden after OLT. Aim of this study was to study safety, feasibility and the clinical and biochemical changes before and after endoscopic therapy for biliary tract complications after living donor liver transplantation.
 
Patients & Methods: This was a retrospective and prospective study between April 2014 and December 2015, we reviewed the medical records of 108 patients with LDLL. ERCP procedure was indicated in 30 patients (28 males, aged 50.13±5.05 years and two females, aged 51±7 years) for biliary tract complications after living donor liver transplantation at the National Liver Institute.
 
Results: Biliary stricture was the highest reported complication (56.7%) followed by leakage (53.3%). The lowest were dilatation of common bile duct (sphincter of Oddi dysfunction), and cholangitis; each of them accounts for 3.3% from the total complication. Post ERCP complications were pancreatitis and bleeding in one case for each. Most of patients were HCV positive (50%) followed by chronic HCV and HCC (33.3%) the lowest cause was HCC alone (3.3%). Five patients suffering from pleural effusion prior to ERCP, mild ascites in 28 cases and moderate in two cases, all patients were cardiologically free. The frequency of complication was like one, two and three complications in 21, 7 and 2 cases respectively. The timing of complications was: In ≤3 month, 16 patients developed complication, 22 patients developed complication in 4-12 month, while only three patients developed complication >1 year. Post ERCP complications included mild pancreatitis and GIT bleeding in one patient for each, there were significant changes regarding all liver profile after LDLT before any complication and on the day of presentation (during complication) and between the last one and follow-up (one month) after ERCP therapy (p<0.05). However, there was no significant difference in liver profile between before any complication and follow-up (one month) after ERCP therapy (p>0.05).
 
Conclusion & Recommendation: ERCP was safe and effective in the treatment of post liver transplant biliary complications and should be recommended for all patients in this setting.