8^th International Conference on Clinical Gastroenterology & Hepatology October 3-5, 2016 Toronto, Canada

Biography:

A. Aziz Aadam, is a therapeutic endoscopist with specialized expertise in gastrointestinal oncology as well as complex pancreas and biliary disorders. He completed his fellowship in gastroenterology at the Medical College of Wisconsin in Milwaukee, WI and completed an additional year of interventional endoscopy training at Northwestern University in Chicago. He is currently the Director of Developmental Endoscopy and is leading the initiative in endoscopic submucosal dissection (ESD) at Northwestern University in Chicago, IL.

Abstract:

Endoscopic submucosal dissection (ESD) is a new endoscopic technique for the treatment of early stage neoplasia in the digestive tract.  ESD allows en bloc resection in comparison to endoscopic mucosal resection (EMR) which is often performed in piecemeal fashion.  Understanding of the appropriate indications for ESD is paramount prior to starting an ESD program.  En bloc resection is associated with a lower recurrence rates compared to piecemeal EMR.  During the presentation the endoscopic technique for ESD will be discussed in detail.  Additionally, the prerequisite training and equipment necesssary for a successful ESD program will be reviewed.  A multi-disciplinary approach is critical to ensure the best possible patient outcomes.  Lastly, the optimal methods of patient and provider education will be discussed.

Biography:

Bing-Rong Liu has completed his MD in 2002 from Chongqing Medical University. He appointed as the director of gastrointestinal department of the Second Affiliated Hospital of Harbin Medical University in June 2004. He has developed so many endoscopic new techniques and published more than 20 papers in reputed journals.

Abstract:

1. Endoscopic retrograde appendicitis therapy (ERAT):

Inspired by the success of emergency endoscopic retrograde cholangiopancreatography (ERCP) in treating acute cholangitis, we developed a minimally invasive method named ERAT to diagnose and treat acute appendicitis. We first reported this technique in DDW 2011. At present, there are more than 20 medical centers in China to carry out the ERAT technique. ERAT provide a new procedure for the treatment of acute appendicitis with rapid pain relief and short recovery time.

2. Liu peroral endoscopic myotomy (Liu-POEM):

Peroral endoscopic myotomy (POEM) has emerged as one approach to treat esophageal achalasia. Tunnellization and the myotomy are the key procedures. Submucosal tunneling requires one-third to one-half of the total operation time. For improvement of POEM procedure, we performed myotomy and tunneling as one step and then closed the entry site as before. We performed the modified procedure more than 60 cases.

3. Endoscopic Fenestration:

The treatment of pancreatic pseudocyst is challenging and difficult. Although endoscopic therapy of pancreatic pseudocyst is considering first line therapy, there are some cases requiring surgical intervention or repeated endoscopic drainage procedures. We described endoscopic fenestration for treatment of large pancreatic pseudocyst in 3 cases. Endoscopic fenestration could be obtaining sufficient drainage which avoids pancreatic pseudocyst recurrence. The pseudocyst cavity was gradually reduced and healed after endoscopic fenestration.

4. Transrectal Gallbladder-Preserving Cholecystolithotomy (TRGPC):

Transcolonic NOTES was not used in human cases due to the fecal contamination. We have developed a detachable balloon to keep the distal colonic cavity sterile and performed cholecystolithotomy and polypectomy with gallbladder preserved in 36 patients by the end of May 2016. Transrectal NOTES gallbladder-preserving operation provides a novel alternative approach of treating gallbladder polyps and stones.

5. Endoscopic submucosal dissection for losing weight:

The gastric endoscopic submucosal dissection (ESD) as a new bariatric technique can affect weight gain. Previous animal experimental study suggested that ESD of one thirds of the stomach fundus can effectively and durably decrease the volume of stomach, thus significantly affect weight gain.

Biography:

Raúl A. Brizuela Quintanilla is the Head of Therapeutic Endoscopy and Gastroenterology Departament in the National Center of Minimal Access Surgery. Havana. Cuba, a Titular Professor of Medicina from Havana University School of Medicine. He has published more than 51 articles in reputable journals and contributed in 4 textbooks specialty. It has presented more than 50 papers in national and international events and is a member of the Cuban Society of Minimal Access Surgery and Gastroenterology.

Abstract:

An observational, descriptive study of the records of 53 endoscopic retrograde cholangiopancreatography (ERCP) performed on 31 patients of paediatric age with suspected biliopancreatic disorders at the National Center for Minimal Access Surgery was performed over a period of 2 years and 7 months, from 11 February 2013 to 28 July 2015. Of the total, 8 patients (27%) were male, and 22 (73%) female; 14 (26%) were diagnostic and 39 (74%) therapeutic. The primary indication was to study pain with elevated enzymes in 27 (50%), and the main diagnosis was postoperative benign common bile duct-anastomosis stricture in 14 patients (26%), followed by 10 normal ERCP (19%). The intervention used was endoscopic sphincterotomy (16) for placement of prosthesis (7), followed in frequency by stone extraction (6). There were complications in 2 cases, one (2%) in 21 therapeutic procedures, and one (2%) at diagnosis. Mortality was zero. Our results show the high diagnostic usefulness and therapeutic success of ERCP with minimal risk and complications in paediatric patients.

Biography:

Hiu Yee KWAN is an Assiantant Professor in the School of Chinese Medicine, Hong Kong Baptist University. She is interested in studying obesity, colorectal cancer and nonalcoholic fatty liver diseases. She has published over 40 research papers and review articles in the areas of lipidomics, obesity, cancers and nutrition.

Abstract:

Schisandrin B (SchB) is one of the most abundant and bioactive dibenzocyclooctadiene derivatives found in the fruit of Schisandra chinensis. Here, we investigated the potential therapeutic effects of SchB on non-alcoholic fatty-liver disease (NAFLD). In lipidomic study, ingenuity pathway analysis has highlighted palmitate biosynthesis metabolic pathway in the liver samples of SchB-treated high-fat-diet-(HFD)-fed mice. Further experiments showed that the SchB treatment reduced expression and activity of fatty acid synthase, expressions of hepatic mature sterol regulatory element binding protein-1 and tumor necrosis factor-α, and hepatic level of palmitic acid which is known to promote progression of steatosis to steatohepatitis. Furthermore, the treatment also activated nuclear factor-erythroid-2-related factor 2 which is known to attenuate the progression of NASH-related fibrosis. Interestingly, in fasting mice, a single high-dose SchB induced transient lipolysis and increased the expressions of adipose triglyceride lipase and phospho-hormone sensitive lipase. The treatment also increased the plasma cholesterol levels, 3-hydroxy-3-methylglutaryl-CoA reductase activity and reduced the hepatic low-density-lipoprotein receptor expression in these mice. Our data not only suggest SchB is a potential therapeutic agent for NAFLD, but also provided important information for a safe consumption of SchB because SchB overdosed under fasting condition will have adverse effects on lipid metabolism.

Biography:

Lulu Xu is an MD-PhD based in China Pharmaceutical University which located in Nanking, China, where she has completed her bachelor's degree.

Abstract:

With the wide clinically application of isoniazid (INH) for tuberculosis treatment, its hepatotoxicity is emerging as a most common adverse effect. Demethyleneberberine (DMB) is a natural product existing in Chinese herb, which plays an important role in protecting against liver disease.

Methods: To investigate the potential effect of DMB against INH-induced liver injury, 8-week-old male C57 mice were given INH (150mg/kg) for 3 weeks. The mice were administrated DMB (10 and 20mg/kg) or a positive control drug Tiopronin (50mg/kg) via enterocoelia concurrently. Serum levels of aspartate aminotransferase (AST), and liver homogenate glutathione (GSH), malondialdehyde (MDA), total cholesterol (TC) and triglyceride (TG) were measured. The expression levels of CYP2E1 and ER stress associative protein were determined. Section of livers were collected for photographic and microscopic observation by hematoxylin and eosin (HE) staining.

Results: DMB protected the liver function with significantly lowered the serum AST lever. Lipid-lowering effect of DMB was observed with reductions in liver TG and TC, which consisted with the observation of HE stained sections, reflected that DMB dose-dependently reversed the INH-induced-liver injury, as there were much less lipid droplets depositing inside the parenchyma cells. The benefits of DMB were associated with increased GSH and decreased MDA activity and CYP2E1 expression in the livers. Further more DMB remarkably inhibited ER stress by downregulating UPR (GRP78) and ATF4-CHOP pathway.

Conclusion: DMB exerts protective effect against INH-induced-liver injury in mice, which maybe associated with its regulation of lipid metabolism, reduction of CYP2E1 expression and inhibition of ER stress.

Biography:

Mr Pawan Mathur MS FRCS [Gen Surg] is a General, Colorectal & Laparoscopic Surgeon at The Royal Free London NHS Foundation Hospitals. His specialist interest is in Colorectal Conditions such as haemorrhoids (piles) anal fissures, anal fistulae, ulcerative colitis/ Crohns Disease, Pelvic Floor conditions and Colorectal Cancer. Mr Mathur qualified from St Thomas’ Hospital Medical School in 1990. He undertook a postgraduate research degree at the Royal Marsden and Chelsea & Westminster Hospitals and was awarded a MS thesis for his work examining the role of manipulating tumour blood supply on chemotherapeutic drug uptake in Colorectal Liver Metastases. He maintains an active interest in surgical research and continues to publish in peer-reviewed journals. In this regard he is Clinical Research Lead for Surgery in the Trust. He is currently the Principal Investigator on a variety of randomized surgical clinical trials. He also holds an Honarary Senior Lectureship at UCL Medical School, which allows him to pursue his main research interest in colorectal cancer.

Abstract:

The author will describe the incidence and clinical presenation of colorectal strictures; a investigation pathway will be proposed. The management options will be discussed including the placement of SEMS (Self Expanding Metatalic Stents).  CT characetristics we recommend to ensure successful deployment will be presented.

Our 17 year exeperinece in SEMs will be presented, including deployment and clinical success rates, complication and failure rates. These are compared to the worlds literature on thris topic.  Management of benign colorectal strictures will also be discussed.

A comparative study of the performance of gastroenterologists and interventional radiologists/ colorectal endoscopists in SEMS placement in our unit will be presented. An analysis of the viability of a regional cnetralised SEMs service within the London Cancer Netwowrk will be presented

A summary of the world literature on the subject of SEMS will be presented leading to up to date results from the UK CrEST trial.

A mamagement algorithym for the management of patients with benign and malignant colorectal structures will be proposed.

Biography:

Ghadah is a 4th year medical student at King Saud University, Riyadh ,Saudi Arabia.

Abstract:

Background: Although small bowel biopsy is considered as the gold standard for diagnosis of celiac disease (CD) detection of autoantibodies is usually the initial step in diagnosis of CD.

Objective: This study was performed to assess the performance of each celiac specific auto antibody against the gold standard. 

Methods: This retrospective study included 267 patients with clinical suspicion of CD who underwent investigations for diagnosis of CD between March 2011 and June 2014 at King Khalid University Hospital, Riyadh. The panel of celiac specific antibodies tested comprised of anti-gliadin IgG and IgA, anti-tissue Transglutaminase IgG  (anti-tTGG) and IgA (anti-tTGA), anti-endomysium and anti-reticulin antibodies. Anti-endomysium and anti-reticulin antibodies were tested by immunofluorescence and the others were assessed by ELISA.

Results: Out of the total only 61 patients including 35 females and 26 males (mean age 26+11 years) were subjected to small bowel biopsy testing with 37 positive and 24 negative results. Among the six autoantibodies assessed anti-tTGA had a sensitivity of 97.3%, specificity of 83%, positive predictive value (PPV) of 90% and a negative predictive value (NPV) of 95%.  Anti-endomysium antibody had a sensitivity of 62.1%, specificity of 95.7%, PPV of 95.8% and NPV of 62.2%. None of the other autoantibodies displayed any notable performance. Receiver operator curve analysis also confirmed the diagnostic accuracy of anti-tTGA with 90.3% area under curve (AUC) followed by anti-endomysium antibody with 70% AUC.

Conclusion: In the presence of relevant history anti-TGA as a single test can be used as an initial screening test for CD.   

Biography:

Rasha has completed her MSc from Al-Mustansiriyah University and worked as a lecturer at University of Kufa college of Medicine/Iraq. She has published 4 papers in college of medicine journals. She is currently a second year PhD student at Sheffield Hallam University/ UK.

Abstract:

The inflammatory cytokine Interleukin 1 (IL-1) is an important mediator of inflammation and tissue damage in inflammatory bowel disease (IBD). The activity of IL-1 is inhibited by a natural inhibitor: interleukin 1 receptor antagonist (IL-1Ra). The balance between IL-1 and IL-1Ra plays a vital role in diseases. We investigated whether inflammatory bowel disease could be induced spontaneously by the removal of IL-1Ra in mice. Histological staining was performed on BALB/C mice to characterize the morphology and enzyme activity of the small intestine from different ages and genotypes. Wild type mice served as a negative control. Twenty well oriented villi/crypt units and villus width at midvillus in longitudinal tissue sections were measured in the jejunum and ileum. The number of goblet cells per villi was determined. Immunohistochemical staining was performed to localise and detect MUC2, MUC5AC, MMP2, MMP9, ADAMTS1, IL-1β and TNFα. The results showed that there was a significant decrease in the villi/crypts units' height in the jejunum and ileum whereas the width of the villi was increased in the jejunum and decreased in the ileum. The number of goblet cells per villi was increased in knockout mice compared with wild type mice. Research is ongoing for the analysis of the immunohistochemistry. We conclude that IL-1Ra knockout mice could act as a model for inflammatory bowel disease highlighting the importance of IL-1 in this disorder.

Biography:

Pochamana Phisalprapa, M.D. is a gastroenterologist and medical instructor at Faculty of Medicine Siriraj Hospital, Mahidol University. She has completed her M.Sc. in Health Economics and Health Care Management at Chulalongkorn University. She has published more 10 papers in reputed journals.

Abstract:

Background & Aims:Non-alcoholic fatty liver disease (NAFLD) can be early diagnosed by noninvasive ultrasonography. Currently, there is no cost-effectiveness analysis of ultrasonography screening with intensive weight reduction program in metabolic syndrome patients. This study aimed to estimate costs and clinical outcomes of such program in Thailand. Methods:A cost-effectiveness analysis using decision tree and Markov models to estimate lifetime costs and health benefits of screening program versus no screening based on a cohort of 509 Thai metabolic syndrome patients from the largest university hospital in Thailand under societal perspective. Effectiveness and utility parameters were based on literatures, while costs and mortality parameters were determined using Thailand database. Costs were presented as year 2014 United States Dollar (USD) values. The results were reported as incremental cost-effectiveness ratios (ICERs) in USD per quality-adjusted life year (QALY) gained with discount rate of 3%. A series of sensitivity analyses including a Monte Carlo simulation were performed to assess the influence of parameter uncertainty on the results. Results:Ultrasonography screening of 50 years-old metabolic syndrome patients with intensive weight reduction program was cost-effective with ICERs of 958 USD/QALY gained when compared with no screening. According to willingness-to-pay of Thailand (4,848 USD/QALY gained), the probability of being cost-effective was 67%. Screening at ages before 45 years was cost-savings while screening at age between 45-64 years was cost-effective. Conclusion:For patients with metabolic syndromes, ultrasonography screening for NAFLD with intensive weight reduction program is a cost-effective program in Thailand. Our findings can be used as part of evidence-informed decision making.

Biography:

Dr. Perillo graduated with a Bachelor of Science degree in Medical Technology from the Faculty of Pharmacy, University of Santo Tomas, finishing as Cum Laude. He obtained his medical degree from the Faculty of Medicine and Surgery, University of Santo Tomas in 2012, where he had been on the dean’s list for three years. He finished his post-graduate internship in Cardinal Santos Medical Center in 2013, being awarded as the Most Outstanding Intern. Currently, he is a third year internal medicine resident in the above-mentioned hospital.

Abstract:

Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity defined as a clinical syndrome in which two insults to the liver are operating simultaneously, one of them being ongoing and chronic, and the other, acute. The objective is to determine the causes and clinical profiles of ACLF at Cardinal Santos Medical Center in the Philippines, and in so doing, find instruments to help physicians predict mortality. This retrospective study was conducted at the Department of Internal Medicine of Cardinal Santos Medical Center. This study included all the patients who met the inclusion criteria of ACLF based on the Asian Pacific Association for the Study of the Liver (APASL) criteria from 2013-2015. Comparison between the survivors and non-survivors was done using the Mann-Whitney U test as a statistical tool. Associations of sex, encephalopathy, ascites and acute insults to mortality were determined by the Fisher-Exact test. Logistic regression was used to determine the important factors to predict mortality. The leading acute insult identified was alcohol accounting for 25.8%. Mortality is associated with the following: elevated bilirubin, elevated INR, low PT % Activity, elevated AST, elevated ALT, elevated creatinine, elevated MELD and elevated MELDNa. Significant association between encephalopathy and mortality was detected at 5% level of significance. The probability of death in patients with ACLF increased with the rise in bilirubin, INR, AST, ALT or creatinine levels. Encephalopathy is associated to “death due to ACLF”. Based on initial analysis, the following factors are the significant predictors of mortality: MELD, MELDNa and INR.

Biography:

Inggar Armytasari completed her bachelor of medicine at the age of 21 from Gadjah Mada University. Currently she is undergoing a clinical rotation at Sardjito Hospital, Yogyakarta. Her interest is in Gastrointestinal Department, especially in Pediatric Gastroenterology.

Abstract:

Inflammatory bowel disease (IBD) is an idiopathic inflammatoric disease in gastrointestinal tract. The clinical signs of IBD include chronic diarrhea, with or without mucous and/or with or without rectal bleeding. It hasn’t surely been known that there is a positive correlation between clinical sign and colorectal mucosal lesion severity in the IBD patients.

This study aims to determine the relationship between clinical sign in inflammatory bowel disease patients with the varying colorectal mucosal lesion. The study was conducted in a retrospective cross sectional using the medical records data from both inpatient dan outpatient with IBD in Sardjito General Hospital from January 2012 until July 2014.

From 65 data (42 men, 23 women, age 18 to 97 years old (49,94±18,25)), there is an insignificant weak positive correlation between clinical signs and lesion severity in IBD (p=0,0916, r=0,211), also in proctitis (p=0,1543, r=0,2876). Meanwhile in left-sided colitis, the correlation is insignificant and has a very weak positive correlation (p=0,9518, r=0,0125).

The only significant and stronger correlation is the correlation between rectal bleeding and lesion severity in the proctitis patients with p=0,0053 and r=0,5310.

So it can be concluded that there is an insignificant weak positive correlation between clinical signs and lesion severity in IBD, except for the proctitis where the correlation between rectal bleeding and lesion severuty is rather high. From this conclusion we can assume that clinical signs only cannot reflect the diseasse severuty of IBD, with the exception of proctitis where the eseverity of rectal bleeding can also depict the severity of the lesion.