16^th International Conference on Gastroenterology and Digestive Disorders August 06-07, 2018 Abu Dhabi, UAE

Biography:

Julio Murra-Saca is the gastroenterologist chief of gastroenterology at Hospital Centro de Emergencias San Salvador, El Salvador working in private practice in a gastrointestinal endoscopy unit performing diagnostic and therapeutic endoscopy. One of his main skills is the management of gastrointestinal bleeding as well as endoscopic resection of giant polyps of the colon. He has great experience in the therapeutic use of argon plasma coagulation in the management of multiple conditions in gastrointestinal endoscopy. He also performs intragastric balloons for obesity with 13 years of experience in this area.

Abstract:

Background: El Salvador Atlas of Gastrointestinal Video Endoscopy is an internet based digital video atlas for educational purposes that has been on the web for 18 years with more than 4700 video clips and images. Endoscopy is a visually oriented discipline. Video clips, by virtue of their dynamic nature, provide greater visual detail of gastrointestinal anatomy and pathology than photographic images.

Methods: Endoscopic procedure, endoscopy, enteroscopy, colonoscopy ERCP were digitally captured in real time, edited and correlated with corresponding pathology, radiology and surgery for each completed clip, the final completed clip were rendered in MPEG-1 format and subsequently converted to RealMedia for on-demand viewing as streaming video via internet. The user interface is server generated dynamic HTLM pages, with relational database system backend.

Conclusion: El Salvador Atlas of Gastrointestinal Video Endoscopy represent internet base, fully digital, educational video atlas of gastroenterology which integrates multiple endoscopic images modalities with relevant surgical, pathological and radiologic data. The substitution of video clips for still images will provide greater educational benefit. El Salvador Atlas of Gastrointestinal Video Endoscopy may represent an educational milestone for the dissemination of knowledge to the practicing physician, trainee and medical students.

Biography:

Sravan Thumati is pursuing his Post-graduate from the Department of Medical Gastroenterology Kilpauk medical college Chennai India.

Abstract:

Aim: The study aimed to compare and validate the results of fibroscan versus liver biopsy among chronic HBV patients who are not candidates for treatment according to AASLD Guidelines.

Methods: 54 chronic HBV patients who are having a standard indication for liver biopsy were included. Patients were subjected to liver biopsy and fibroscan study.

Results: The mean age of our patients was 42 years. Study population showed male predominance as the number of males was 40 cases (74.07) while the number of females was 14 (25.29). The mean ALT was 35.01U/L and the mean AST level was 30.89U/L. HBV DNA levels were quite variable with a minimum of <1000 IU/ML and a maximum of 1,01,62,000 IU/ML with a mean of 2,613,52.

Conclusion: Liver stiffness assessment was found to be correlated with liver fibrosis however the results of liver biopsy were not similar to fibroscan results. Most of the case had a fibroscan result less than liver biopsy results by Metavir score. Only cases with Metavir score of F0 coincided with fibroscan results. Liver stiffness measurement could be used as a predictor for liver fibrosis in chronic HBV patients but still liver biopsy may be required to confirm treatment decisions.

Biography:

Dr. Seema Khan is a pediatric gastroenterologist in Washington, District of Columbia and is affiliated with multiple hospitals in the area, including Children's National Medical Center and MedStar Georgetown University Hospital. She received her medical degree from Aga Khan Medical College and has been in practice for more than 20 years. Dr. Khan accepts several types of health insurance, listed below. She is one of 14 doctors at Children's National Medical Center and one of 14 at MedStar Georgetown University Hospital who specialize in Pediatric Gastroenterology.

Abstract:

Background: Eosinophilic Esophagitis (EoE) is a chronic immunologic disorder characterized by esophageal dysfunction and dense esophageal eosinophilia. The incidence rates are 5.1 and 7 per 100,000 person years in children and adults, respectively. An initial histologic response to proton pump inhibitor has long been viewed as favoring gastroesophageal reflux disease and its use is thus proposed in the diagnostic approach. It is evident from recent literature that PPI therapy has an anti-eosinophil effect, thereby inducing a histologic response independent of GERD status.

Aim: Investigate the response to the initial PPI regimen in children with EoE.

Methods: We performed a retrospective review of data pertaining to children referred to the multidisciplinary EoE clinic at CNMC. We included children with EoE (peak>15 EOS/HPF at any esophageal level) who underwent a histologic reassessment after 8 weeks of PPI (1-3 mg/kg/day) at CNMC. Histologic response was defined as 5-15 EOS/HPF and remission as <5 EOS/HPF.

Results: We reviewed data for 71 children with EoE, age 8 mo-17 yr (6 yr), Caucasian 26 (36.6%) and 43% African Americans (AA) among non-Caucasians. Only 15 children met inclusion criteria comprising of 73% males, 53% non-Caucasians including 33% AA, age range 1-17 year (7.6 year). Histologic remission with minimal symptomatic improvement occurred in only one patient. The pre-PPI and post-PPI therapy peak EOS/HPF were 10-100 (52) and 1-100 (54), p=0.74).

Conclusions: We did not observe PPI therapy as sufficient to alter esophageal histologic status favorably in contrast to adults with EoE. To our knowledge, our Pediatric EoE, is the only uniquely non Caucasian predominant cohort reported to date. The retrospective nature, variable regimens, and absence of formal GERD investigations are limitations of the study. Extending the analysis to additional patients is expected to provide useful insight into PPI effects in EoE.

Biography:

Ravi Anand is currently pursuing his DM Gastroenterology Degree from a prestigious medical college and hospital from Chennai located in south India. He has completed his MBBS and MD Medicine from Banaras Hindu University. He is interested in field of luminal gastroenterology and various endoscopic procedures. He was working in the gastroenterology department before joining his DM course immediately after passing his MD Medicine and gained his initial training in various endoscopic procedures there. His main aim is to bring the benefit of the best of gastroenterology for the people who are still in need of it for better diagnosis and management of their illness

Abstract:

Introduction: Corrosive injuries are one of the important public health issues especially in developing countries like India causing a spectrum of complications.

Aim: To review clinical and endoscopic findings of patients with acute corrosive injury and management of these patients.

Methods: In this prospective study, clinical data of 61 patients were collected from July 2016 to July 2017 who came at our centre with corrosive ingestion within 48 hrs. Full clinical examination was done and chest x ray was taken. Patients with no evidence of perforation underwent upper GI endoscopy and initial conservative management was instituted. Corrosive injuries were graded by Zargar’s classification.

Results: Out of 61 patients, complete evaluation was possible only in 53 patients. 37 male and 16 female patients were evaluated and mean age was 29 years. Mean time interval of presentation was 17 hours and volume of corrosive ingestion was 20 to 150 ml. Most common corrosive in our study were acids that included hydrochloric acid (n=28), phenyl (n=9), sulphuric acid (n=2), nitric acid (n=2), aqua regia (n=1) along with alkali (n=9) and two cases of kerosene ingestion. Five cases were accidental while 48 cases were of suicidal ingestion. Most common clinical feature in our study were oropharyngeal injuries (n=43), epigastric pain (n=34), sialorrohea (n=31), vomiting (n=30), odynophagia (n=25) and dysphagia (n=23). 46 patients had esophageal injuries (grade 1=27, 2a=9, 2b=5 and 3=5) while 40 patients had gastric injuries (grade 1=18, 2a=9, 2b=5 and 3=8). Ryle’s Tube (RT) insertion was done in six patients with grade 2b and 3 injuries. Patients who came for review after 4 to 8 weeks improved spontaneously with grade 1 and 2a injuries. Five patients with 2b and 3 injuries required feeding jejunostomy initially while all six patients with RT required dilatation after four weeks.

Conclusion: Patients with acute corrosive injury can be assessed reliably and accurately by upper GI endoscopy and proper clinical examination and managed accordingly.

Biography:

K S Somsekhar Rao is a well-known gastroenterologist and hepatologist in Apollo Hospitals, Hyderabad, India.

Abstract:

Statement of the Problem: Hepatitis B and hepatitis C are widely prevalent all over the world and Eradication of these viruses is a challenge. Among the challenges in eradicating these chronic hepatitis viruses, most important aspect is to identify the existing pool of patients and treating them. Once the source of infection (positive patients) is identified and controlled (undetectable viral load), eradication of these viruses is a possibility in near future.

Aim: Eradication of chronic viral hepatitis at IEJA.

Methods: Identified a very high prevalent zone for hepatitis C in the state of Telangana, India. Every individual in the village was screened for hepatitis B and hepatitis C. All patients were consulted by a hepatologist and necessary investigations were done. All patients requiring treatment for hepatitis C were started on antivirals, all their family members and others who were found to be negative for the viruses were counseled regarding the modes of transmission and care to be taken. All the patients who were started on treatment were followed up regularly and compliance on drug intake was monitored. All these patients were tested for SVR (Sustained Virological Response) after 6 months (24 weeks) of completion of Treatment. Repeat screening for hepatitis C in the same village for all the individuals after 7 months did not show any new positive HCV cases.

Results: 300 patients were included in the study. 30 patients were found to be cirrhotics at baseline and antivirals (sofosbuvir+daclatasvir) were given for a period of 24 weeks. Patients with serum creatinine more than 3 mg/dl were excluded. Three patients with HCC were identified and were not included in the study. 227 patients who were non-cirrhotics were treated with a combination of sofosbuvir and daclatasvir for a period of 12 weeks. 40 patients had undetectable HCV RNA at baseline and they were not started on antivirals. Out of 257 patients who were started on antivirals 230 patients achieved SVR.

Conclusion: Prevalence of cirrhosis is about 10% in anti HCV positive population. Incidence of HCC is about 1% in anti HCV positive patients. Treatment with a combination of sofosbuvir and daclatasvir achieved SVR in about 90% population in pangenotypic hepatitis C infection. Identifying positive patients in the community who are the source of infection and treating them effectively with an improved awareness among the general public and close contacts of infected patients can decrease the spread of chronic viral hepatitis and help in eradicating these viruses effectively.

Biography:

Mahmoud Hallal has completed his MBchB on 1987 from Baghdad University and his Internal Medicine Diploma 1991 and Gastroenterology Diploma 1993 from American University of Beirut. (AUBMC), Post University training in therapeutic Bilio Pancreatic (ERCP) and Invasive endoscopy at CHU de Nice November 1998, MBA Master Of Business Administration, hospital administration 2017 Islamic University Of Lebanon. He is an LSGE (Lebanese society of gastroenterology) Active Member since 1994 and an international ASGE member since 2005 and ESGE member since 2015. He participated as speaker and workshop leader and expert trainer in hands-on endoscopy training in Lebanon and Egypt. Currently he is the Gastroenterology fellowship program coordinator at Zahraa University Hospital affiliated with Beirut Arab University (BAU) from 2011 till now and the Clinical instructor At Lebanese University faculty of medical sciences since 2017 till now.

Abstract:

The worldwide approach to upper GI bleeding is becoming uniform, both medical and endoscopic management. It is evident that in the most of cases high dose PPI should be started to downstage the endoscopic lesion and decrease the need for endoscopic intervention, but should not delay early endoscopy (within 24 h). Endoscopic hemostatic therapy is indicated for pts with high-risk stigmata and no single method of endoscopic thermal coagulative therapy is superior to another. Clips, thermo-coagulation or sclerosant agents should be used in pts with high risk lesions alone or in combination with epinephrine injection. When there is no active bleeding but a red protuberance is seen in the center of an ulcer, most would inject with epinephrine and in addition, use APC, heat probe, or clips. Epinephrine injection alone provides suboptimal efficacy and should be used in combination with another method. IV erythromycin will help but should not delay the decision of urgent endoscopy; when oozing is seen from an ulcer site, injection with epinephrine and or the argon plasma coagulator used, followed by ethanolamine. Other endoscopic modalities can be used including hemospray, rubber band ligations. Patients admitted to the hospital whose GI bleeding requires therapeutic endoscopy, but they do not take a second look on the day after the endoscopic examination unless active bleeding recurs. None of the International Board members would perform any therapeutic measures if melena was the presenting symptom and a clean ulcer base was present in the duodenum. Biopsy specimens for Helicobacter are usually taken if hemostasis has been achieved. All skills have a learning curve and we recommend use what you are expert in stopping bleeding. The GI endoscopist should achieve their skills based on workshops and hands-on training to be certified in therapeutic endoscopic management.

Biography:

Haifaa M Malaekah is a General surgery and Colorectal Consultant and Member of Saudi Society for Colon and Rectal Surgery and Manager of Postgraduate Professional Development Program at simulation center. He is a certified healthcare simulation educator. Currently, he is working at King Abdullah bin Abdulaziz University Hospital at surgical Department. In addition, he has obtained a Master’s degree in Epidemiology and Medical Statistics. He has accomplished 2 years of Fellowship in Colorectal Surgery at 2015, University de Montreal and 1 year Fellowship in Surgical Simulation, McGill University, Canada. He continued working in McGill University as Postdoctoral Fellow for 6 months. He has an interest in medical education, simulation and researches.

Abstract:

Background & Aim: Despite the effectiveness of Clinical Pathways (CP) in reducing healthcare cost and minimizing variability in the management of particular diseases, there are no standardized pathways for common conditions such as appendicitis. This study aimed to determine whether implementation of a pathway for appendicitis leads to improved patient care.

Methods: A systematic review was performed of PUBMED, MEDLINE and Cochrane Library from 1974 to December 2015. The inclusion criteria were human, appendicitis, CP, original article and English language. 37 of the identified studies comprised of 16,006 participants met selection criteria.

Results: There was a clear definition of the appendicitis pathway within 30 articles. Appendicitis was diagnosed on the basis of clinical and laboratory findings. 43% of the studies added radiological investigations. There was a clear definition for discharge criteria in 16/37 studies. 10 studies reported time of follow-up for their patients (5-28 days). Operative time was the most commonly used outcome measure 25/37 (67.5 %). Nine articles reported the Length of Stay (LOS) for non-complicated appendicitis, mean=1.3 days and 8 articles for complicated appendicitis, mean=6.26 days. The majority of studies investigated the accuracy of the pathway in the diagnosis of appendicitis by looking at the incidence of a normal appendix, mean=9.15%. Four articles documented the mean cost of patient care, mean=$4,874.14.

Conclusion: There is not a standardized definition of appendicitis pathway components within the medical literature. These studies suggested that an appendicitis pathway decreases the duration of hospitalization and prove useful as a means to minimize costs.

Biography:

Deepak Ghuliani is currently working as Professor of Surgery at Maulana Azad Medical College, New Delhi has a special interest in Gastrointestinal and Endocrine surgery. He is working as a General Surgeon, he has a vast experience in all types of gastrointestinal and hepatobiliary cases especially the GI Oncology. Besides clinical practice he has a passion for teaching and all types of academic activities. He has several publications in National and International journals. He is working as Professor of Surgery not only is he conducting research and teaching undergraduate and postgraduate medical students but also actively involved in conferences, CME’s, skills workshops, updates in the role of speaker, chairperson, judge, trainer and also a quiz master.

Abstract:

Colorectal Cancer (CRC), commonest gastrointestinal malignancy develops from the progression of acquired or hereditary premalignant lesions. 75% of colorectal cancers are “sporadic while a potential genetic influence is identified in the remaining 25% of patients. The tumor results from complex interactions between several risk factors (environ­mental, dietary, familial and hereditary) which become relevant during the different stages of colorectal carcinogenesis. The Chromosomal Instability (CIN)/Loss of Heterozygosity (LOH) pathway and the Microsatellite Instability (MIN)/Replication Error (RER) pathway are two well-described genetic pathways leading to the development of colorectal adenocarcinoma. Most, if not all colonic cancers develop from a precursor polyp. The most common neoplastic polyp with malignant potential is the adenoma .It follows the adenoma-carcinoma sequence where inactivation of APC gene sets the stage for accumulation of genetic damage leading to a malignancy. Carcinomas are found in 0% to 4% adenomas. Histologically divided as tubular, villous and tubulovillous- the size and histology of adenomas are independent risk factors. Serrated polyps - another type of neoplastic polyp are mixed hyperplastic and adenomatous polyps. The sessile and traditional serrated types are the definite precursors for colonic cancers. Adenomas, may occur sporadically or as part of one of the hereditary syndromes like Familial Adenomatous Polyposis (FAP), Attenuated FAP, Gardener’s and Turcot’s syndrome. FAP is the commonest adenomatous polyposis syndrome with 100 to 1000 polyps all over the colon, more in the left and associated with 1% of colonic cancers. Besides, several hamartomatous polyposis syndromes like Peutz-Jeghers syndrome and Juvenile polyposis syndrome have markedly increased risk of colonic cancer with development of extra-colonic manifestations, both malignant and non-malignant. Hereditary Non Polyposis Colonic Cancer (HNPCC) is the most common familial colorectal syndrome associated with 2-3% of colorectal cancers. The associated colonic cancer occurs at an early age (44 years), 70% are right sided with a 40% risk of synchronous and metachronous cancers. Other premalignant conditions include inflammatory bowel diseases: Ulcerative colitis and Crohn’s disease where the risk is directly proportional to extent and duration of disease. Thus early identification of these conditions not only provides the opportunity to either prevent the progression to cancer or diagnose cancer at an early curable stage but also allows for appropriate surveillance and management, which varies considerably between syndromes. Clinical testing for germline mutations should occur in the setting of appropriate genetic counseling and offer predictive testing for family members.

Biography:

Shahram Agah is the Director of Endoscopy ward and Colorectal Research Center at Rasoule-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran, where he works as a professor in the field of Gastroenterology and Hepatology. His basic education and professional training have been in Iran, however, he attended at Chemnitz hospital, Germany in 2001 and Rush University, Chicago, USA in 2017 for better experience in therapeutic endoscopy and Endosonography. He has traveled to Australia to obtain more experience in advanced endoscopy (EMR and ESD) and some collaborative researches. He is the principle investigator on several clinical trials in gastrointestinal disorder.

Abstract:

About 70%–80% of colorectal neoplasia arises from conventional adenomatous polyps. Polypectomy reduced the risk of colorectal cancer by the order of 75%–90%. 80% to 90% of polyps are smaller than 10 mm. Morphological description (considering Paris classification), Size estimation (smaller or larger than 10 mm), Relation to the surrounding mucosa: (e.g. Saddle distribution over a fold, or an invasive lesion. Safe polypectomy implies the ability to resect and completely remove a polyp while achieving hemostasis and maintaining the integrity of the colonic wall. Polyps of ≤6 mm can be safely removed by cold snaring. Electrocoagulation with a blend or cutting setting should be used for polyps >10 mm. The different snare is using for the polypectomy. Try to put the polyp at 5 to 6 o’clock position at the time of resection. Small, flat sessile polyps, pedunculated polyps with very large pedicles, large flat sessile lesions or laterally spreading tumors are challenging polyps. For the first one, the cold snare is the safest method. For the second one, post-polypectomy hemorrhage is the most problems which can be prevented with endoloop or clip. For laterally spreading tumor or large sessile lesion, EMR is recommended. Injection is recommended in lesion >10 mm in the right, >15 mm in the left and in both parts if a lesion is hidden behind a fold. With moderate expertise, EMR of the lesions occupies more than one-third of the circumference of the colonic wall or maximally crosses over two haustral folds. Submucosal sequential injection and piecemeal resection after 1 to 2 ml saline or gelfusion. Resect most inaccessible first. Consider removal of some normal tissues. Consider snare tip soft coagulation of removed tissues rim for reduction of recurrence.

Biography:

M A Ezzel Arab is a Professor of Internal Medicine and Hepatology. He is the Founder of Intervention and Hepatoma Unit at the National Hepatology and Tropical Medicine Research Institute (NHTMRI) since 2007. He is a member of the steering committee which put the Egyptian guidelines for HCC (2011) which was sponsored by the Egyptian Society of Liver Cancer (ESLC).

Abstract:

Hepatocellular Carcinoma (HCC) is increasing worldwide and particularly in Egypt, where the prevalence of hepatitis C viral (HCV) infection, a well-established HCC risk factor, is the highest in the world. Direct-acting antivirals (DAAs) have completely changed the panorama of hepatitis C due to their high efficacy and optimal safety profile. The impact of DAA-based treatment on the incidence of HCC in patients with cirrhosis and particularly on the incidence of HCC recurrence after successful curative treatment has emerged as a controversial issue with potential clinical implications. As Egypt achieved the highest number (>1.5 million) of treated patients by DAAs globally up till now, it is so important to evaluate its situation in this issue. The talk will highlight on the following items: Discrepancy regarding the occurrence and recurrence of HCC, highlight on some Egyptian studies and possible factors contributing to increased HCC incidence/recurrence by DAAs.