Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 13th Euro-Global Gastroenterology Conference Rome, Italy.

Day 2 :

Keynote Forum

Bashar Attar

Cook County Health and Hospitals System, USA

Keynote: Subclinical exocrine pancreatic insufficiency (EPI): A disease that merits treatment
Conference Series Gastro Congress 2018 International Conference Keynote Speaker Bashar Attar photo
Biography:

Bashar M Attar is a Professor of Medicine and Surgery at Rush University Medical Center in Chicago, Illinois, USA. He is also the system-wide Chairman of Gastroenterology and Hepatology at Cook County Health and Hospitals System. He has special interest acute and chronic pancreatitis as well as potential mechanisms contributing to pancreatic cancer. He has an avid interest in viral hepatitis, metabolic and cholestatic liver disorders including bile transport. He is the Recipient of the President Diversity Award by the ASGE (2010); Recipient of the prestigious National “Parker J Palmer Courage to Teach Award” by the ACGME (2015) which was granted in recognition of extraordinary accomplishment in Graduate Medical Education. He has been recently elected (2017) to the Humanism Honor Society in recognition of exemplary service, integrity, clinical excellence and compassion.

Abstract:

Introduction: Exocrine pancreatic insufficiency (EPI) is one of the long-term consequences of chronic pancreatitis (CP). Majority of patients with EPI are undiagnosed or undertreated.

Study Design: We prospectively evaluated 200 consecutive individuals seen in a pancreatic outpatient practice. These individuals were screened on 2 occasions to determine their baseline stool elastase excretion. The 200 individuals were segmented into 4 distinct groups: a)“Normals” (n=105) with stool elastase >500 ug/g stool, received no treatment; b) “Minimal EPI” (n=60) with stool elastase >200 to <500 ug/g stool, received 3000 IU of a standard pancreatic enzyme preparation (Creon) with their 2 ingested meals; c) “Moderate EPI” (n=23) with stool elastase >100 to 200 ug/g stool, received 12,000 IU of the same pancreatic enzyme preparation with each meal; d) “Severe/Overt EPI” (n=12) with stool elastase <100 ug /g stool, received 24,000 IU of the same pancreatic enzyme preparation with each meal and with a bedtime snack.


Results: These groups presented with abdominal pain, bloating, flatulence, diarrhea, large bulky stools, and greasy stools. Symptoms were graded (1-10) at entry and monthly for 3 months. Symptom scores decreased in all groups. The response to therapy was maximal in those with most severe disease identified by their greatest reduction in stool elastase at entry. Lesser responses were seen in the other groups and mired the severity of the disease at entry as defined by their stool elastase levels.
 

Conclusions: We conclude that 1) pancreatic elastase in stool enable the segmentation of individuals into distinct subgroups of EPI. 2) pancreatic elastase in stool enables identification of not only overt EPI but those with minimal and moderate EPI. 3) therapy with pancreatic enzyme preparations can be individualized based upon the concentration of pancreatic elastase in stools. 4) individuals with “subclinical” EPI with stool elastase level of 100-500 improve with treatment.

Keynote Forum

Davor Štimac

Clinical Hospital Center of Rijeka - University of Rijeka, Croatia

Keynote: Endoscopic treatment of obesity: Challenge for gastroenterologists
Conference Series Gastro Congress 2018 International Conference Keynote Speaker Davor Štimac photo
Biography:

Davor Štimac is a Professor in the university of rijeka. He is Director of Clinical Hospital Center Rijeka from 2016. Head of the Clinic for Internal Medicine of the Clinical Hospital Center Rijeka from the year 2014. Deputy Head of the Department of Internal Medicine of the Faculty of Medicine of the University of Rijeka from the year 2001. He is member in the following societies, Croatian Medical Association- member of the Executive Board, Croatian Gastroenterological Society - Member of the Steering Committee, Croatian Pancreatic Club –President, Croatian Society for Thickness - the President, Croatian Society for Health Care Quality Improvement-Vice President, World Gastroenterology Organization (WGO)- a member of the Global Guidelines and Publication Board and a member of the Trainers' Trainers (TTT), United European Gastroenterology Federation (UEGF)- a member of the General Assembly, European Association of Gastroenterology,
Endoscopy and Nutrition (EAGEN)- Member of the Board of Directors, European Board for Gastroenterology and Hepatology (EBGH)- Member of the Management Board, UEMS Section for Gastroenterology- HLZ representative. He had published about 121articles. Editor for 7 books and had 21 chapters in the books, 71 work in other indices.

Abstract:

According to emerging role of endoscopic procedures in the treatment of obesity and rapid changes in endoscopic technologies and techniques, the current state of endoscopic management of obesity will be presented. Endoluminal interventions performed entirely through the GI tract by using flexible endoscopy offer the potential for an ambulatory weight loss procedure that may be safer and more cost-effective compared with current surgical approaches. Endoscopic techniques attempt to mimic the anatomic features of bariatric surgery. Accordingly, there are two main endoscopic weight loss modalities - restrictive and malabsorptive. Restrictive procedures act to decrease gastric volume by space-occupying prosthesis and/or by suturing or stapling devices, while malabsorptive procedures tend to create malabsorption by preventing food contact with the duodenum and proximal jejunum. The former include intragastric balloon treatment, endoluminal vertical gastroplasty, transoral gastroplasty and transoral endoscopic restrictive implant system, while the latter include duodenojejunal bypass sleeve. Gastroduodenojejunal bypass sleeve is a combination of both procedures. Except for intragastric balloon, all mentioned procedures are rather new, tested on a small number of human subjects, with a high rate of success, but with limited knowledge on safety and long-term efficacy. The role of gastric electrical stimulation and intragastric injections of botulinum toxin in obesity treatment is also considered as is the role of minimally invasive bariatric endoscopic interventions.

Break: Networking & Refreshments 10:20-10:45 @ Foyer
  • Workshop
Location: Holiday Inn Rome Aurelia

Session Introduction

Raihan ASMA

Bangabandhu Sheikh Mujib Medical University, Bangladesh

Title: Association of Helicobacter pylori and anaemia
Speaker
Biography:

A S M A Raihan has been working in the department of Gastroenterology, Banga bandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. His research interest is focused in Irritable bowel syndrome, inflammatory bowel disease, peptic ulcer disease and Helicobacter pylori infection. His important works are profile of ulcerative colitis in Bangladesh, presented in APDW, 2006, profile of patients of Crohn's disease in Bangladesh, Symptomatic overlap in patients with diarrhoea predominant irritable bowel syndrome and microscopic colitis in Bangladeshi population and histopathological alteration in post infectious irritable bowel syndrome. He developed a clinical scoring system to differentiate difficult to diagnose cases of intestinal tuberculosis and Crohn’s disease and presented his work in Asia Pacific Digestive Week, Kobe, Japan in 2016. He has got more than 50 publications and he supervised more than 50 theses.

Abstract:

Background: Helicobacter pylori (H. pylori) associated gastritis may cause iron deficiency anaemia. Therefore, this infection should be diagnosed and cured.

Aim: This study is aimed to find out association of H. pylori infection and iron deficiency anaemia.

Methods: Association of H. pylori infection and anaemia was studied in dyspeptic patients. Those who were found to be normal at upper GI endoscopy were included in this study. Rapid urease test was done to detect H. pylori infection. H. pylori positive patients were considered as group A and H. pylori negative as group B. A total of 194 patients (aged 18 to 60 years) of both sexes were included, 134 belonged to group A and 60 to group B. Five ml of blood was collected from each patients for estimation of hemoglobin level, serum ferritin, mean corpuscular hemoglobin (MCH) and mean corpuscular volume (MCV). Iron deficiency anaemia was defined as hemoglobin(Hb) concentration <120 g/L in men and <110 g/L in women, serum ferritin <12 μg/L, mean corpuscular haemoglobin (MCH) <27 pg, and mean corpuscular volume (MCV) <80 fL. Iron deficiency was considered when serum ferritin was <12 μg/L (70).


Results & Conclusions: Serum ferritin was higher in H. pylori negative group than H. pylori positive group. In the multiple regression model H. pylori infection was associated with 28.8% decrease of serum ferritin (95% CI=-4.85 to-9.1); r2=0.271). The mean MCV was found to be 85.45±6.93 (in fL) in group A and 88.73±4.58 ( in fL) group B. The difference was statistically significant (p<0.05). The mean MCH was significantly lower in group A than group B. In male patients, the mean Hb% was lower than group B and the difference was statistically significant (p<0.05). In female patients mean Hb% of both groups were almost similar. So it appears that H. pylori infection is associated with iron deficiency anaemia.

Speaker
Biography:

Siddique Abu Raihan is working as Assistant Professor in gastroenterology in Seikh Sayera Khatun Medical College Hospital in Gopalgonj. He obtained his MBBS from Dhaka Medical College in the year of 2003. After which he earned his MRCP degree from the Royal College of Physicians in the UK on 2011, and subsequently his MD in Gastroenterology from BSMMU (Bangabandhu Seikh Mujib Medical University on 2016. He had extensive training in all modalities of both diagnostic and therapeutic G. I. Endoscopy in Bangabandhu Seilkh Mujib Medical Universirty for 4 years from the year 2012 to 2016. He later joined as Specialty doctor in gastroenterology in Medway Maritime Hospital in UK. He worked there for 1 year and then came back to Bangladesh and was appointed as assistant professor in gastroenterology in Seikh Sayera Khatun Medical College in Gopalgonj, Bangladesh. Besides doing his clinical jobs like doing gastroenterology clinics, ward round and endoscopic procedures in Seikh Sayera Khatun Medical College, he is also involved in teaching and is a resource person in the Medical Education department as an expert in curriculum development. He has got special interest and vast exposure to management of the patients with IBD, intestinal TB and functional bowel disorder.

Abstract:

In the study 63 H. pylori positive patients with peptic ulcer disease were randomized for eradication therapy for H. pylori for two weeks. Four regimens were used: ECA consisting of Esemoprazole (20 mg bid), Clarithromycin (500 mg bid) and Amoxicillin (1 gm bid), EAL- consisting of Esemoprazole (20mg bid), Amoxicillin (1gm bid), Levofloxaxin (500 mg once daily), EAT consisting of Esemoprazole (20mg bid), Amoxicillin (1gm bid), Tetracycline (500 mg bid) and ETL consisting of Esemoprazole (20 mg bid), Tetracycline (500mg bid) and Levofloxaxin (500 mg once daily). Out of 63 patients 13 dropped out. Six weeks after completion of therapy upper GI endoscopy was repeated to see endoscopic improvement and RUT (rapid urease test) was carried out. Conclusive result was obtained in 40 cases in RUT. Eradication therapy showed no statistically significant difference in different regimens
(p>0.05). Endoscopic improvement occurred in 33% to 71% patients in different regimens. Thirty six patients were found to be RUT negative and 4 were found to be RUT positive. Negativity rate ranged from 83% to 100% in different regimens. This result appears to be acceptable, good and even excellent with ETL.

  • Inflammatory Bowel Diseases | Gastrointestinal Pathology | Advanced Nutrition and Dietetics in Gastroenterology | Digestive Diseases
Location: Holiday Inn Rome Aurelia
Speaker

Chair

Davor timac

Clinical Hospital Center of Rijeka - University of Rijeka, Croatia

Speaker

Co-Chair

Fong-Fong Chu

The First Affiliated Hospital - HUST, China

Session Introduction

Iftikhar Ahmed

University of Southampton - Al-Faisal University, UK

Title: Volatile organic metabolites as novel, non-invasive diagnostic biomarkers in Inflammatory Bowel Disease

Time : 12:15- 12:40

Speaker
Biography:

Iftikhar Ahmed is a consultant gastroenterologist at University Hospital Southampton NHS Foundation Trust and visiting consultant at East Sussex Hospitals NHS foundation trust Eastbourne. He is also a Hon. Senior clinical lecturer at the University of Southampton UK. His research interests include investigating the changes in the smell of faeces and breathe in order to understand the pathophysiological mechanisms of GI disorders and to develop a non-invasive biomarker. Through formal laboratory research, He studied the faecal volatile metabolomics profiles of patients with Liver disease ( NAFLD) , IBD and irritable bowel syndrome (IBS) in comparison with healthy individuals, and was awarded the degree of Doctorate of Medicine (MD) by University of the Bristol in 2012. He has collaborative research experience with international colleagues, presented his work at both national and international conferences, and was awarded travel grants and prizes for the best
abstracts and oral presentations on various occasions. He is on the reviewer panel of several national and international journals, including Gut, PLOS One, Journal of Gastrointestinal and Liver Disease and BMJ.

Abstract:

The Diagnosis of inflammatory bowel disease (IBD) requires extensive and often invasive investigations including colonoscopy and histology and places a heavy burden, both on healthcare resources, because of the cost, and on the individual, in times of disease-related disability and poor quality of life. Recently, there has been increasing interest in noninvasive biomarkers to diagnose IBD and to monitor the disease activity. There is growing scientific interest in the investigation of volatile metabolites and numbers of studies have focused on the utilization of non-invasive biomarkers in the diagnosis of GI disease. The development of sophisticated analytical techniques has enabled the study and interpretation of changes in the faecal and breath volatile organic metabolites (VOMs) and its correlation with the pathophysiological mechanisms in IBD. VOMs are the chemicals that are the products and intermediates of metabolism and may be altered during the diseases process. Changes in the signature of VOMs could potentially provide diagnostic information about health and disease. Multiple studies have reported the differences in VOM profiles of healthy controls vs. patients with IBD other GI disorders. VOM profiles have been used to segregate patients by disease activity and the type of disease. The correlation of VOMs with Microbiota is interesting and supports the hypothesis of gut microbial dysbiosis in the etiology of IBD. This provides an important platform to explore the role of dysbiosis in IBD and other GI disorders pathogenesis and development of novel therapeutic targets. In future, further understanding of faecal VOMs may lead to the development of a rapid and simple point of care diagnosis and monitoring of IBD.

Speaker
Biography:

Silvia Melgar received her PhD in Immunology from Umeå University in Sweden, followed by a Postdoctoral Fellowship and a Senior Research Scientist position at AstraZeneca R&D Mölndal, Sweden. She is currently an APC Faculty Investigator under the Host - Microbe Dialogue Research theme in the APC Microbiome Ireland Research Institute of University College Cork (UCC), Ireland. She joined the APC in 2008 as a Principal Scientist under the GlaxoSmithKline-APC collaboration and became an Investigator in 2012. Her research interests include 1) the identification of novel molecular mechanisms associated to diet - host - bacteria interactions and their relevance to health and intestinal disorders such as inflammatory bowel disease (IBD) and colorectal cancer; 2) identification and pre-clinical evaluation of novel therapies for inflammatory and malignant conditions in the gastrointestinal tract in animal models and in in vitro cell systems.

Abstract:

Westernized diet, defined by high contents of saturated fats and sucrose, is associated with the development of several diseases including metabolic syndrome, obesity and cancer. Intestinal inflammatory responses are mediated by a complex crosstalk between the environment, microbiota and the immune system. Alterations in any of these systems can lead to development of gastrointestinal conditions such as inflammatory bowel diseases (IBD). Triggering factors for IBD and colitis-associated cancer (CAC) include environmental factors (e.g. stress), gut microbiota composition and diet. Recent
reports indicate that a specific pathobiont outgrowth in IL-10-/- mice fed with a milk derived fat diet aggravated colitis. Epidemiological data have also identified processed meats and saturated fat as risk factors for IBD and colon cancer. Prebiotics are selectively fermentable ingredients that can change the composition and/or activity of the intestinal microbiota, which can lead to beneficial effects on the host. Short chain fatty acids (SCFAs) are the fermentation products of prebiotic digestion by the colonic commensal microbiota, with the most abundant SCFAs being butyrate, acetate and propionate. SCFAs, especially butyrate, act as source of energy for epithelial cells as well as being immune modulatory and helping dampening inflammation. In this talk, I’ll discuss our findings emanating from in vitro and in vivo studies investigating the effect of diets, bacteria and bacterial metabolites on intestinal epithelial cell responses and in experimental models of colitis and CAC. To date, we have data showing that high fat diets can positively and negatively affect the outcome of colitis and CAC by regulating the microbiota, microbial metabolites and host epithelial and immune responses. In addition, we have generated mechanistic insights on the role of individual SCFAs and IBD-associated pathobionts such as adherent and invasive Escherichia coli (AIEC) on intestinal epithelial cell responses.

Break: Lunch Break 13:05-14:05 @ hotel Restaurants
Speaker
Biography:

Jaya Maheshwari is a prominent dignified Surgeon and has pursued minimal access surgery moving further in her career. During her academic journey she has been awarded a couple of fellowships in laparoscopy from the top institutes. Ongoing with her pursuit for academic excellence she specialized and got certified in advance proctology and lasers. She is currently the Co-Convener for the FIAGES Board. She presently heads the Department of Advance Proctology and Department of Laparoscopic Surgery in Jyoti Hospital, Jaipur. Her rich clinical career in performing thousands of surgeries over a span of nearly one and half decade, and her vision for quality and excellence made her establish a first of its kind department, specifically in proctocare and minimal access surgeries. The department offers a plethora of surgeries and the most advance techniques, like the STARR for severe constipation, staplers and lasers for piles, fistula and fissures, and various types of mesh repairs for all hernias.

Abstract:

Pilonidal sinus is a chronic inflammatory condition which is caused due to involution of hair fragment into the gluteal or natal region. It is also called as inflammatory disease of gluteal region. It is twice as common in males between 15-25 years of age. Occasionally it occurs in different region like umbilicus, nose, groin, axilla, clitoris, interdigital tract, suprapubic area, penis or occiput. The present report highlights the condition in a 24-year old male with discharging sinus in the gluteal cleft and itching from the past one-month. Diagnosis of the diseases is straightforward clinically with discharging sinus and multiple pits in the natal cleft, and choice of particular surgical approach was laser pilonidoplasty. The procedure was performed under local anaesthesia with 1470 nm diode laser as beam source, with radial fibre, which would destroy the deep fistula system of the sinus. A 600 micron fibre with a special glass top (CORONA) fistula probe fibre with power settings at 10 watt and energy dosage at 100 joules per cm was used. The patient recovered completely and returned to work within 2 months. The procedure does not involve any painful dressings post operatively. In our experience, laser pilonidoplasty is the choice of procedure for the disease as there are less chances of morbidity and recurrence and better chances of early healing and cure of the disease. Hair removal is maintained until wounds are healed, after which laser hair removal is recommended of the local area. The lasers thus, prove to be an attractive treatment alternate for pilonidal sinus.

Raihan A S M A

Bangabandhu Sheikh Mujib Medical University, Bangladesh

Title: Association of nontuberculous mycobacteria (NTM) with Crohn's disease (CD)
Speaker
Biography:

Raihan A S M A is currently working in the Department of Gastroenterology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. His research interest is focused in Irritable bowel syndrome, inflammatory bowel disease, peptic ulcer disease and Helicobacter pylori infection. His important works are: profile of ulcerative colitis in Bangladesh, presented in APDW (2006); profile of patients of Crohn's disease in Bangladesh; symptomatic overlap in patients with diarrhoea predominant irritable bowel syndrome and microscopic colitis in Bangladeshi population and histopathological alteration in post infectious irritable bowel syndrome. He has developed a clinical scoring system to differentiate difficult to diagnose cases of intestinal tuberculosis and Crohn's disease and presented his work at Asia Pacific Digestive Week, Kobe, Japan in 2016. He has more than 50 publications and has supervised more than 50 theses.

Abstract:

Introduction: The most widely held hypothesis on the pathogenesis of IBD (Inflammatory Bowel Disease) is that overly aggressive acquired (T cell) immune responses to a subset of commensal enteric bacteria develop in genetically susceptible hosts, & environmental factors precipitate the onset or reactivation of disease. But it is almost universally accepted that a host genetic predisposition is critical for development of CD. Among bacteria Mycobacterium avium subsp paratuberculosis (MAP) has shown high prevalence although not uniformly. This large variation may be due to differences in DNA extraction techniques or to geographical variations in the prevalence and modes of transmission of MAP.

Aim & Objectives: This prospective study aimed to see the association of NTM with Crohn’s disease.

Methods: Patients of CD were included in the study as case. Patients of IBS (Irritable Bowel Syndrome) or suspected colorectal malignancy who were found to be normal at colonoscopy and colonic biopsy was normal, were included in the study as control. Two bites of biopsy from the lesion in CD patients were taken for NTM by PCR. In control group two bites were taken for histopathology and two bites were taken for NTM PCR from left side of the colon. We used ITS primer for NTM and IS 900 primer for Mycobacterium avium sub species paratuberculososis (MAP) in PCR. We extracted the DNA from tissue for PCR using QIAamp DNA mini kit.

Results: We studied 34 CD patients and 34 controls. Out of 34 cases 28 were found to be positive for nontuberculous mycobacteria (NTM) and 6 were negative. Out of 34 controls only 8 were found to be positive for nontuberculous mycobacteria (NTM) and 26 were negative. Odds ratio 15.17 (95 % CI 4.07-60.75) and P value was significant (0.001). Among them we couldn’t detect MAP neither in cases nor in controls.
 

Conclusions: From this study it appears that NTM other than MAP may have association with Crohn's disease in Bangladesh.

Biljana Vuletić

University of Kragujevac, Serbia

Title: Gluten related diseases
Speaker
Biography:

Biljana Vuletic is Associate Professor of Pediatrics at the Faculty of Medical Sciences University of Kragujevac and Chief of the Department of Gastroenterology of Pediatric clinic and a full ESPGHAN member. She received her medical degree from the Medical Faculty University of Belgrade. She started her residency in pediatrics at the University Children’s Hospital University of Belgrade. There she also trained in Pediatric endoscopy and ultrasonography. She was finished two hands-on Courses in UK, Sheffield Children’s Hospital She has been accepted by OMI foundation, Austria, for Observer ship program at the Medical University of Graz, Universities Kinderklinik LKH Graz two times. Her mainly clinical interests include chronic intestinal failure, coeliac disease and clinical nutrition. She has summary 168 publications including authored or co-authored papers in peer-reviewed journals and also chapters in the national Monographs and Textbooks
published in Serbia.

Abstract:

Gluten, the largest complex protein component of a cereal grain, contains high levels of gliadin and glutenin known as prolamines. Similarly, a high concentration of prolamines was found in barley and rye, so the term ‘gluten’ has become synonymous with the protein content in all three cereals. Researchers have identified gluten to be the main etiologic and causative agent of coeliac disease (CD) in genetically predisposed individuals and a strict gluten-free diet is an essential part of treatment. Not so long ago, the possible role of gluten as the causative agent of other illnesses and not just coeliac disease (CD) spurred the considerable attention of both the medical and general public. Another well-known condition that requires the elimination of wheat proteins is the wheat allergy (WA). At the same time, many people who do not suffer from either CD or WA, exhibit a variety of symptoms that disappear while on a gluten-free diet (GFD). The term non-coeliac gluten sensitivity (NCGS) was used to describe this status which, together with CD and WA, makes a spectrum of gluten-mediated disorders. What non-coeliac gluten sensitivity actually implies is the subject of discussion and the prevalence of such conditions is still unknown. In some patients, the symptoms decrease while adhering to GFD because they have eliminated gluten, while in others, their recovery results from the avoidance of non-protein cereal components, such as sugars belonging to FODMAPs. The confusion about the benefits of GFD resulted in its widespread adoption as the most popular dietary regimen in the USA today, followed by the multibillion-dollar gluten-free food industry (GF). Although the exclusion of gluten from the diet is essential in patients with confirmed CD and BA, the fact is that they make up only a small percentage of those following a GFD, mostly for personal but not medical reasons. Strict adherence to GFD is difficult and costly and involves the risk of nutritional deficiency and weight gain (81%) due to the hyper caloric content of commercial gluten-free foods. GF products are not enriched and may be deficient in fibers, thiamine, folate, vitamin A, magnesium, calcium, and iron. In addition, there is no evidence of a need to eliminate other sources of gluten (rye, barley) in case of non-coeliac gluten sensitivity.

Kenan Yusif Zade

Military Hospital of State Border Service, Azerbaijan

Title: The effectiveness of the new method of radial sphincterotomy
Speaker
Biography:

Kenan Yusif Zade holds an MD and PhD Degree from Azerbaijan Medical University, Azerbaijan. He also holds an MBA Degree from Maastricht School of Management, The Netherlands and EMBA Degree from ADA University, Azerbaijan. He is the Head of Military Hospital of State Border Service, Azerbaijan. His professional fields are general surgery, gastroenterology and invasive endoscopy. In 2007, he founded an Association of Turkish-Azerbaijani Endoscopic Surgeons. He is also the President-Elect (2017-2019) of Ambroise Paré International Military Surgery Forum (APIMSF). His second education is Business Management.

Abstract:

Introduction: In choledocholithiasis subject to the size of the stone and the anatomical structure of the papilla the size of the cross-section in sphincterotomy may vary. Sufficiently large incision in sphincterotomy leads to the increase in the incidence of complications after ERCP as perforation, cholangitis, and pancreatitis.


Materials & Methodology: We performed 77 ERCP (endoscopic retrograde cholangio-pancreatography) operations in patients with a diagnosis of "choledocholithiasis". In the first group (59 patients) we performed standard sphincterotomy incision in 11, 12 or 13 o’clock direction, in the second group (18 patients) - "radial" sphincterotomy. The technique of "radial" sphincterotomy we developed allows to make several lateral incisions in 11, 12 and 13 o’clock directions. Thus, the main incision can be made up to transverse fold, and other radial incisions shall be made below the transverse folds, without going beyond the boundaries of the assumed course of intramural choledoch. Thus, the complete cross section of the incision with additional insections at the radial sphincterotomy becomes 1.5 times larger than the main incision in standard sphincterotomy.

Results: In the first group periampullary diverticulum was 16.7%, while in the second group - 47.4%. Number of stones in the first group – 2.25±0.49, in the second – 2.22±0.32, sizes of the stones – 10.07±4.93 and 19.01±3.31 mm, respectively. In the first group, complications occurred in 3 (5.08%) patients: in 1 of them - post-ERCP pancreatitis, in 2 - bleeding during the session. In the second group, only 1 (5.5%) patient had pancreatitis and other early and late complications. In the first group with 3 patients - the common bile duct stone removal was achieved in two sessions with a few day interval, the remaining - in a single session. In the 2nd group, all patients required only one session. No cases of mortality occurred in any of the groups.

Conclusions: Radial sphincterotomy technique was substantiated from anatomical and mathematical aspects. The proposed technique is a safe way to increase the area of dissected papillae ensuring efficient removal of large stones through such incision.

Speaker
Biography:

Ziad Aljarad has a master degree in gastroenterology and Hepatology from Aleppo University. He is interested in clinical research. He has four published research papers and a published book. He is also interested in teaching principles of clinical research to medical students. He has participated in many research activities and conferences, and he is a member of Continuous Medical Learning and Research Center (CMERC) in Aleppo University. He is also interested in Humanitarian work. He was the coordinator of health care in the Syrian Arab Red Crescent- Aleppo Branch, and now he is the National Professional Officer for TB, HIV and Hepatitis in the World Health Organization (WHO)

Abstract:

Statement of the Problem: In 1953, Aird et al. found an association between blood group A and gastric cancer, and between blood group O and peptic ulcer disease (PUD). Further research demonstrated relationships between ABO blood groups and some diseases. No studies included Rh blood groups in the analysis. There is a controversy among studies investigating the association of ABO blood groups with gastric cancer and PUD. This study aims to investigate the relationship between Rh and ABO blood groups and the incidence of gastric cancer and PUD. To our knowledge, this is the first study that includes Rh blood groups in the investigation.


Methodology: We chose case-control design. Participants underwent esophagogastro - duodenoscopy (EGD) during 2016 and 2017 in Aleppo University hospital. We did ABO and Rh typing for all participants. Biopsies were done when indicated. We formed four case groups: benign PUD group (n=276), benign gastric ulcer group (n=125), benign duodenal ulcer group (n=169), gastric cancer group (n=26). The control group (n=276) consisted of participants whose EGDs were normal or revealed only gastritis or duodenitis. We used ODDs Ratio with 95% confidence interval and P-value to evaluate statistical significance of differences between groups.

Findings: There is no significant relationship between Rh blood groups and gastric cancer or PUD. There is no relationship between ABO blood groups and PUD. There is an increased risk of gastric cancer among blood group A. Non-A groups revealed no significant risk. 100% of biopsies showed H. pylori.


Conclusion: After comparing our findings to available literature, we suggest larger-scale studies to investigate the association of non-A groups with gastric cancer, and Rh groups with gastric cancer and PUD. We recommend studying the feasibility of establishing screening programs for gastric cancer in people with blood group A. We should determine the prevalence of H.pylori infection in Syria.

Break: Networking & Refreshments 16:10-16:30 @ Foyer