Day 1 :
Keynote Forum
Indran Indrakrishnan
Emory University School of Medicine, U.S.A
Keynote: Identification & correction of decreasing cancer screening colonoscopy rate during the economic recession
Time : 10:00-10:45 A.M.
Biography:
Indran B. Indrakrishnan, M.D is a Clinical Professor of Medicine at the Emory University School of Medicine and the Medical Director of GDC Endoscopy center LLC & Gwinnett Digestive Clinic PC in Atlanta GA. He is a past president and currently on the Board of Directors of Georgia Gastroenterological and Endoscopic Society. He has served and has been serving on numerous committees including American College of Gastroenterology, American College of Physicians, Medical Association of Georgia and AAAHc. He has organized & spoken at many CME conferences across the country & won many distinguished awards from national and international scientific organizations. He has published several clinical and basic science research articles and is in the editorial boards of peer review journals. Indrakrishnan has a special interest in the management & public education of colorectal cancer and he is on the Board of Directors of Fight Colorectal Cancer - a National nonprofit patient advocacy organization.
Abstract:
Colon cancer is a silent killer & is the second common cause of cancer deaths in the country. This very same colon cancer is one of the most easily curable cancer if detected early & it is preventable by removal of precancerous polyps by the screening colonoscopy. This colon cancer screening colonoscopy is highly recommended by multiple governmental agencies and professional societies for people at or over 50 years and others who are at higher risk even before they reach 50. The rate of this life saving screening colonoscopy has decreased reentry mainly due to no shows & cancellations at our center. This is presumably due to various impacts from economic recession which include but not limited to loss of jobs, high deductible/high co payments from the insurance companies. When faced with economic insecurity, asymptomatic individuals may be unable to afford screening colonoscopy, or may perceive it to be less important than competing demands for their more limited resources. Reduced screening rates during the recession may ultimately increase health care costs and result in cancer related deaths. This is consistent with literature in other fields of medicine. For instance, during difficult economic times women are more likely to be diagnosed with advanced rather than local breast cancer.
The purpose of this study is to identify the incidence & causes of no shows and cancellations for the screening colonoscopies at our center. Once done, then apply corrective measures if any and thereby reduce the no shows & cancellations and increase the screening colonoscopy rate . This is important for good quality patient care.
First , we analyzed the data of the previous years before the economic recession and compared with the present one.
Total number of screening colonoscopies scheduled: 443
Total Cancellation: 35 ( 7.9%)
Commercial Insurance screening colonoscopies (CISC) scheduled: 312
CISC Cancellation: 25 (8%)
Total cancellation/no shows rate decreased from 13.8% in the initial measurement to 7.9% in the re- measurement group.
CISC cancellation rate was 19.9% in the initial measurement & 8% in the re-measurement group. This is a statistically significant decrease with a P value < 0.001.The re-measurement values are not identical to the performance goal but are closer.
The above data was derived from the patients’ encounters where they cancelled the procedures with the endoscopy center. There may be a very large number of patients who declined the screening colonoscopies at the “entry” level at the primary care physicians’ offices due to the unawareness of the screening benefits. We recommend that the primary care physicians offices to specifically emphasize and advise to the patients that their cancer screening colonoscopies are completely covered under preventive care regardless high deductible & co pays .and advise them accordingly at the time of referrals especially when the insurance coverage is complete. The high deductible/high co pay insurance has become rampant under the present economy with employers & insurance companies finding the ways to cut their cost. Advising the patients proactively about the insurance implications in preventive healthcare tests is a commendable practice in continuing to provide a good preventive healthcare to the community. This recommendation is applicable to other preventive screening tests such as Mammograms, PAP smears, PSA & bone density tests.
- Advances in Gastrointestinal Diseases & Gastrointestinal Oncology
Location: Room 1
Session Introduction
Abdul Aziz Aadam
Northwestern University, U.S.A
Title: EMR to ESD: East Meets West. Implementation of an ESD Program at an Academic Medical Center
Time : 10:45- 11:00 A.M.
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.
- Gastrointestinal Surgery & Advances in Liver Diseases
Location: Room 1
Session Introduction
Bing-Rong Liu
Harbin Medical University, China
Title: Gastrointestinal Endoscopic Innovation from China
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.
Raúl A. Brizuela Quintanilla
National Center of Minimal Access Surgery, Cuba
Title: Endoscopic treatment of biliopancreatic diseases in children. Analysis of 31 patients
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.
Hiu Yee Kwan
Hong Kong Baptist University, China
Title: Lipidomic-based investigation into the regulatory effect of Schisandrin B on palmitic acid level in non-alcoholic steatotic livers
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.
Lulu Xu
China Pharmaceutical University, China
Title: Demethyleneberberine attenuates isoniazid-induced-liver injury by reducing CYP2E1 expression and preventing endoplasmic reticulum stress
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.
Pawan Mathur
Royal Free London NHS Fundation Trust, UK
Title: STATE OF THE ART IN THE MANAGEMENT OF BENIGN AND MALIGNANT COLORECTAL STRICTURES
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.