14^th Euro-Global Gastroenterology Conference July 08-09-2019 Zurich, Switzerland

Biography:

Anna Melissa M. Ng is currently in her second year of residency training in the Department of Internal Medicine in West Visayas State University Medical Center, Iloilo City, Philippines.  Her inclination in gastroenterology motivated her to handle and understand gastroenterology cases with the guidance and supervision of her gastroenterology consultants, one of them being Dr. Ike T. Minerva who specializes in interventional endoscopy.

Abstract:

Abstract

Statement of the Problem: Gastric diverticula (GD) are rare and frequently asymptomatic. However, there are cases that present with massive upper gastrointestinal bleeding (UGIB). A search by Gibbons et al revealed only five cases that have shown that intraluminal hemorrhage originated within the diverticulum. We report a 69-year-old female who presented at the emergency room (ER) with massive hematemesis. She had a three-month history of heartburn, epigastric discomfort and vomiting. She eventually developed acute respiratory failure secondary to hypovolemic shock from UGIB.  She was conscious and generally pale, with anicteric sclera and pale conjunctivae. Abdominal examination showed a midline infra-umbilical scar, but was otherwise unremarkable. Diagnostic Work-up: Upper Gastrointestinal Endoscopy (UGIE) revealed pooling of coffee ground mixed with fresh blood and food materials in a diverticulum that seemed to be below the gastro-esophageal junction. Bleeding ulcers at the middle to distal third of the esophagus were also noted. To establish diagnosis, location of the diverticulum and possible surgical intervention, a barium meal was requested that revealed a proximal gastric diverticulum. Narrow Band Imaging (NBI) also showed a gastric mucosa lining the diverticulum. Treatment: The patient was offered definitive treatment through laparoscopic resection but was not amenable during the present admission. Management included a long-term proton pump inhibitor and diet that involved small frequent feedings. Conclusion & Significance: Although most GD are asymptomatic, our patient presented with massive UGIB. To our knowledge, this is the first reported case in the Philippines of GD presenting as hematemesis secondary to intra-diverticular hemorrhage, confirmed with barium swallow and NBI. Recommendations: A high index of suspicion is required to diagnose GD because it can lead to life threatening complications such as massive UGIB; and because definitive treatment is available and complete cure is attainable.

Recent Publications

1. Podda M, Atzeni J, Campanella AM, Saba A, Pisanu A. Syncope with Surprise: An Unexpected Finding of Huge Gastric Diverticulum. Hindawi Publishing Corporation. 2016.
2. Rashid F, Aber A, Iftikhar S. A Review on Gastric Diverticulum. World Journal of Emergency Surgery. 2012; 7:1.
3. Hernandez GH, Soto ICF, Garcia CAJ. Gastric Diverticulum: A Rare Endoscopic Finding. Journal of Hepatology and Gastrointestinal Disorders. 2016; 2:2.
4. Kumar P, Chandra K. A Case of Gastric Diverticulum: Solitary Fundal Diverticulum. Indian Journal of Clinical Practice. 2014; vol 25, No. 4.
5. Feng Y, Zhang Z. Gastric Diverticulum Stimulating A Left Adrenal Mass: A Case Report and Review of Related Literature. Oncology Letters. 2015; 10:2477-2480.
6. Gibbons CP, Harvey L. An Ulcerated Gastric Diverticulum: A Rare Cause of Hematemesis and Melena. Postgrad Med Journal. 1984; 60:693–5.

Biography:

Dr. Miguel Lorenzo Faustino completed his undergraduate degree in Molecular Biology and Biotechnology from the the National Institute of Molecular Biology and Biotechnology in the University of the Philippines. He obtained his medical degree from the University of the Philippines College of Medicine. He is currently completing his Internal Medicine residency training program from the World Citi Medical Center in Quezon City, the Philippines.

Abstract:

Gastric cancer is rare before the age 40. Establishing a diagnosis in this subset of younger patients is challenging because initial symptoms are nonspecific. This case report aims to present a case of diffuse gastric adenocarcinoma in a young patient with the intent of raising awareness on its subtle presentation whose clinical diagnosis is anchored on an astute physician’s high index of suspicion. We report the case of a 35 year old, Filipino male, with no known comorbidities and no family history of malignancy, who complained of early satiety and bothersome postprandial fullness 7 months in evolution. Repeated endoscopic evaluation and CT imaging revealed linitis plastica with a rigid and thickened gastric mucosa. Multiple biopsies taken only showed increased lymphoplasmacytic infiltrates with no evidence of dysplasia, metaplasia or atrophy.  In this experience, subtle presentation, inconclusive results of the diagnostic investigation, and the aggressive biology of the disease underscores the importance of the physician’s high index of suspicion in diagnosing gastric cancer in this subset of patients. Establishing a diagnosis early is crucial so that key interventions may be offered and prolong our patient’s life.

Biography:

Sara Lotfy Asser is a Lecturer in Microbiology and Immunology in Faculty of Medicine of Alexandria University. My passion in virology has always driven me to explore their clinical effects and research into the treatment outcome and their immune evasion strategies. I wish to research more into novel strategies to prepare vaccines and precede these ultramicroscopic bugs in their resistance mechanisms.

Abstract:

HCV direct-acting antivirals revolutionized the treatment outcomes especially in areas considered to be highly endemic as Egypt, where the government adopted a National Treatment Program and successfully reached a large sector of the HCV patients population. High response rate to treatment with Sofosbuvir and Daclatasvir necessitated confirmation of total cure through excluding HCV occult infection. Our aim was to estimate the occurrence of occult HCV in patients treated with Sofosbuvir and Daclatasvir, by detecting HCV RNA in their PBMCs. Quantitative estimation of HCV viral load in serum samples and PBMCs of 40 patients undergoing treatment with Sofosbuvir and Daclatasvir, was done using COBAS AmpliprepTM/COBAS TaqManTM. At the start of treatment serum samples were positive for HCV RNA (ranged from 2.50x10³ – 6101.0x10³). After one month of the treatment our data revealed that serum HCV RNA was negative by PCR. After three months, HCV RNA was detected in PBMCs in 10 out of 40 via RT-PCR. Comparison between the results of HCV RNA in serum and PBMCs by PCR after three months of treatment, showed statistically significant difference of p= 0.001. This reveals the high prevalence of HCV RNA in PBMCs denoting occult HCV infection after combined treatment with Sofosbuvir and Daclatasvir. It also signifies that although the combined treatment was effective in eliminating the virus from the serum, it is less effective in its elimination from the PBMCs. These results also highlight the importance of testing for HCV RNA in PBMCs after end of treatment to confirm total HCV elimination.

Figure:

c², p:  c² and p values for Chi square test for comparing between the two groups

*: Statistically significant at p ≤ 0.05 b

Biography:

Abstract:

Fatty liver is the most common liver disease worldwide. Hyperglycemia and hyperinsulinemia induce lipogenesis, thereby increasing the hepatic pool of fatty acids[1]. Nutritional consultations and lifestyle modification are important in the treatment of non-alcoholic fatty liver disease (NAFLD) [2]. The usual management of NAFLD includes lifestyle counseling to achieve a gradual weight reduction and an increase in physical activity. An intensive lifestyle intervention focused on diet, exercise and behavior modification with a goal of 7–10% weight reduction that leads to significant improvement in liver histology in patients with NASH [19]. Indeed, weight loss improves steatosis [20], reduces hepatic inflammation and hepatocellular injury [21], [22] and improves cardiovascular risk profile. [23]. Several changes in dietary intake have occurred in the past few years, including increased energy intake (24%), and increases in added sugars, flour and cereal products, fruit, added fats and total fat intake[42]. Fatty liver disease in humans is an insulin-resistant condition and the liver over-produces glucose and triglycerides due to impaired insulin action[45]. Fatty liver is an independent predictor of diabetes and cardiovascular disease[46]. There are three major sources for increased liver fat accumulation: excessive delivery of free fatty acids from lipolysis of superficial and visceral fat depots (60%), increased de novo hepatic lipogenesis (30%), and increased nutritional intake (10%)[47].

Biography:

Abstract:

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC) is an immune-mediated chronic intestinal disorder with an unknown etiology. The overexpression of proinflammatory factors such as proinflammatory cytokines is believed to have pivotal role in development of UC. Among them tumor necrosis factor alpha (TNF-α) is identified as a key cytokine. Also it has indicated that the levels of expression of NF-κB reflect development and progression of UC.It has no cure until now and the purpose of treatments are to alleviate signs, lengthening remission and improvement in quality of life in these patients. Different mechanisms for the effects of vitamin D on inherent and acquired immune systems are supposed to reduce inflammation, promote immunological tolerance, and increase the intestinal epithelial integrity. Thus this study was designed to determine the effects of vitamin D supplementation on TNF-α, serum hs-CRP and NF-κB in patients with UC.

Materials and Methods:

In this randomized, double-blind, placebo-controlled study, 50 patients with UC were divided into two groups which the case group received two pearls of vitamin D (2000IU) once/day for 12 weeks and the control group received one placebo capsule and one pearl of vitamin D (1000IU) per day. Serum inflammatory markers, serum hs-CRP and NF-κB were assessed at baseline and the end of the study. Dietary intake and physical activity of patients assessed by a valid questionnaire. Anthropometric and diet measurements were assessed in this study. The SPSS was used for data analysis.

Results:

In this study, 24 patients in case group and 22 in control group Among 50 participants completed the intervention. At the beginning of study, no significant differences were seen in baseline variables between two groups. At the end of 12 weeks there were no significant differences in serum hs-CRP, TNF-α between the case and control group after adjustment for confounders. The level of NF-κB  in both groups increased, but this increase in the low dose group was statistically significant at the end of the study comparing to the beginning( P value = 0.006).

Conclusion:

Supplementation with 2000IU vitamin D daily for 12 weeks made no changes in serum hs-CRP. Serum TNF-α, remained with no change in both groups after adjustment. We recommend supplementation of vitamin D with appropriate dosage in all patients with UC in order to to take advantage of it’s great therapeutic benefits.

Biography:

Shailesh Kumar is a Professor of PGIMER at Dr. Ram Manohar Lohia Hospital, India. His research interests focus on Bariatric Surgery, Diabetes Control after Bariatric surgery along with Diabetes and Obesity.

Abstract:

A 46 years old menopausal female presented to surgical OPD with the complaints of recurrent pain abdomen with vomiting and fever off and on. Pt was a treated case of Koch’s abdomen. Th ere was no history of jaundice and other co- morbidities. On examinations, she had tenderness in Right hypochondrium (RHC) on deep palpation. Rest of the parameters were normal. On Investigation, ultrasonography of abdomen revealed multiple gallstones with Normal CBD. Rest of the abdomen and pelvis were normal. Her blood and urinary examinations were within normal limits. X-ray chest revealed features suggestive of healed tuberculosis. Pt was posted for laparoscopic cholecystectomy. After pneumo-peritoneum, 10 mm optical port was placed in periumbilical area. On diagnostic laparoscopy, whole of the colon was densely adhered to the pariety. Liver, gall bladder and spleen were nor not visible. As falciform ligament and liver was not visible, two working port were inserted in the mid clavicular line both side around 3 inches below the costal margin in an anticipation to de-parietization of the transverse colon to assess the feasibility to proceed. We broke the adhesion between the transverse colon and pariety in the midline and preceded to de-parietisation the whole transverse colon with the help of ultrasonic scissor. After that we could visualised the Liver and Gall bladder and preceded with the laparoscopic cholecystectomy abdominal cavity is the sixth most common extra peritoneal site of tuberculosis. Th ere are diff erent studies that support the crucial role of diagnostic laparoscopy in the diagnosis of abdominal tuberculosis. Th e diagnostic laparoscopy revealed ascetic fluid, violin string adhesion of peritoneum and omental thickness. Peritoneal involvement is a common features and more than half of the patients presents with ascites, lymphadenopathy and stranding of the mesenteric fat. Laparoscopy is normally accepted as an accurate and prompt diagnostic tool in case of suspected abdominal tuberculosis.
Recent Publications
1. Sharma M P and Bhatia V (2004) Abdominal Tuberculosis. Indian J. Med. Res. 120:305-315.
2. D Mistikas, T Kapp and Montmollin de (2016) Laparoscopic diagnosis of abdominal tuberculosis. HippoKratia.
20(2):175.
3. Sinant T, Sheikh M, Ramadan S, Sahwney S and Behbehani A (2002) CT- features in abdominal Tuberculosis: 20
years’ experience. BMC Med imaging. 2:3.

Biography:

Abstract:

Manuscript

A 46 years old menopausal female presented to Surgical OPD with the complaints of recurrent pain abdomen  with vomiting and fever off and on. Pt was a treated case of Koch’s abdomen. There was no history of jaundice and other co- morbidities.

On examinations, she had tenderness in Right Hypochondrium (RHC) on deep palpation. Rest of the Parameters were normal.

On Investigation, ultrasonography of abdomen revealed multiple Gallstones with Normal CBD. Rest of the abdomen and pelvis were normal. Her blood and urinary examinations were within normal limits. X-ray chest revealed features suggestive of healed tuberculosis.

 Pt was posted for Laparoscopic Cholecystectomy.  After pneumo-peritoneum ,10mm Optical port was placed in periumbilical area. On diagnostic laparoscopy, whole of the colon was densely adhered to the pariety (Fig-1a). Liver, Gall blader and Spleen were nor not visible. As Falciform Ligament and  liver was not visible, two working port were inserted in the mid clavicular line both side around 3 inches below the Costal Margin in an anticipation to de-Parietization of the transverse colon to  assess the feasibility to proceed.  We  broke  the adhesion between the transverse colon and  pariety in the midline  and proceeded to de-parietisation the whole transverse colon with the help of ultrasonic scissor (Fig-1b).  After that we could visualised the Liver and Gall bladder (Fig-1c) and proceeded with the Laparoscopic Cholecystectomy

Abdominal cavity is the sixth most common extra peritoneal site of tuberculosis ¹. There are different studies that support the crucial role of diagnostic laparoscopy in the diagnosis of abdominal tuberculosis. The diagnostic laparoscopy revealed ascetic fluid, violin string adhesion of peritoneum and omental thickness². Peritoneal involvement is a common features and more than half of the patients presents with ascites, Lymphadenopathy and stranding of the mesenteric fat³.

Laparoscopy is normally accepted as an accurate and prompt diagnostic tools in case of suspected abdominal tuberculosis.

Biography:

Abstract:

Rationale: Gut microbiota cluster into three enterotypes named the Bacteroides, Prevotella and Ruminococcus. While each person’s microbial “fingerprint” is unique, there are specific patterns seen in those that are healthy and those that have specific illnesses. The objective of the present study was to identify the enterotypes that are possibly associated with Type I Diabetes Mellitus Egyptian patients as well as their possible role in the course of the disease.

Subjects & Methods: The study included 40 T1DM patients as well as  control group of 20 healthy subjects of matched age and sex. Stool specimens were taken from each. Quantitative SYBR Green Real-Time PCR was done for the identification and quantitation of Bacteroides, Prevotella and Ruminocooccus which constitute the core of the three major enterotypes.

Results: Enterotype 1 was the most common enterotype detected in T1DM and control cases (75% versus 65% respectively) with no significant differences between the two groups(P=0.418). Regarding enterotype 2 no significant differences was noted between T1DM patients and control group(25% vs 35% respectively P=0.324). For enterotype 3, it was detected neither in patients with T1DM nor in control cases.

Conclusion: There was no significant difference in the distribution of enterotypes in all study groups. Therefore, collapsing the whole microbiome variations into dominant enterotypes was not appropriate to identify disease association or to be used as a disease biomarker.

Biography:

Abstract:

Introduction:Acute cholangitis(AC)is a pathological condition characterized by an ascending bacterial infection of the biliary ductal system with the obstruction caused by varies etiologies.Endoscopic retrograde cholangiopancreatography (ERCP) is performed as a therapeutic procedure for biliary drainage in acute cholangitis but associated with higher rates of complications respective to other endoscopic procedures. These complications include pancreatitis, bleeding, trauma, and cardiopulmonary problems.

The aim of this study is the detection of any significant relationship between the Tokyo guideline 2018 staging of acute cholangitis and the complicationsassociated with the ERCP modality.

Material and methods :283 patients had been diagnosed with acute cholangitis and underwent ERCP, between January 2015 and February 2018 encountered at the Gastroenterology and Hepatology Department of Timisoara Emergency County Hospital, 43% of the patients are males (n=122), 57% of the patients, are females (n=161).The minimal age of the patients which is 17 years old and the maximal one being  92 years old, the average age of the patients involved in the study is 64 years old.The severity assessment and the staging of all acute cholangitis cases were based on the TG13/18 ; “Grade I” (Mild )comprises 179 patients (63% of the patients), “Grade II” (Moderate) comprises 63 patients (22 % of the patients), whereas “Grade III”(severe) comprises 41 patients (15% of patients).Inclusion in the study was based on the diagnosis of “Acute cholangitis” in the patient’s medical charts. Subsequently, the required data were extracted from the patient’s medical charts. Furthermore, the patients that did not undergo therapeutic ERCP were excluded

Results :ERCP complications are reported only in 34 patients (12%) out of 283 which underwent ERCP . The most common complication was post-sphincterotomy hemorrhage, observed in 17 patients (6% of the patients), acute pancreatitis in 14 patients (5.3% of pacients), other complication in 3 patients (1.06%).

According to TG18 , 11 from 41 Pacients with severe AC had Post ERCP complications (26.8%), 8 from 63 pacients with moderate  AC (12.6%) and 15 from 179 pacients with mild AC (8.3%)

Conclusion : ERCP is the gold standard and first line therapy for acute cholangitis in the department of gastroenterology and hepatology of the county hospital Timisoara but it remains a procedure with many complications. The TG18 could predict higher risk of complication according to the severity of AC

Biography:

Abstract:

Background and Aims: Ulcerative colitis (UC) and Crohn’s disease (CD) are inflammatory bowel diseases (IBD) of unclear etiology that cause substantial morbidity and predispose to colorectal-cancer (CRC). There are two isoforms of STAT3—a and b; STAT3a is pro-inflammatory and anti-apoptotic, while STAT3b has opposing-effects on STAT3a. We determined the contribution systemically of STAT3 to UC and CD pathogenesis by comparing disease severity caused by dextran sodium sulfate (DSS; UC model) or 2, 4, 6-trinitrobenzenesulfonic acid (TNBS; CD model) in mice expressing only STAT3a (D^b/D^b) and in wild-type (WT) mice treated with TTI-101, a small-molecule inhibitor of both isoforms of STAT3.                                                                                                               

Methods: Seven days following administration of DSS in drinking water or two days following a single intra-rectal administration of TNBS, D^b/D^b mice, cage-control (+/+) mice, and WT mice given TTI-101 or vehicle were examined for IBD manifestations; their colons were evaluated for apoptosis of CD4⁺ T cells, levels of STAT3 activation, IL-17A protein expression, and transcriptome alternations.  

Results: IBD manifestations were increased in D^b/D^b transgenic vs. cage-control WT mice and were accompanied by decreased apoptosis of colonic CD4⁺ T cells. Complementing and extending these results, TTI-101 treatment of WT mice prevented IBD, markedly increased apoptosis of colonic CD4⁺ T cells, reduced colon levels of IL17A-producing cells, and down-modulated STAT3-gene targets involved in inflammation, apoptosis-resistance, and colorectal-cancer metastases.

Conclusions: STAT3, especially in CD4⁺ T cells, contributes to the pathogenesis of UC and CD and its targeting may provide a novel approach to disease treatment.

Biography:

Abstract:

Planning and scheduling is one of the critical component for a procedure area to work efficiently. It allows the effective utilization of material and human resource during the given period of time to bring outcomes. Therefore, We streamline the existing booking system by allowing medical teams to manage their case scheduling according to their assign slots. The new system encourages transparency while keeping in mind both doctor’s and patient’s satisfaction.

Initially, the appointment booking for all three procedure rooms were done under one room in the system. As a result, it creats high dis satisfaction among patient and health care provider due t system kiosk.

Juran’s problem solving trilogy was used as quality improvement methodology was devised to run the project. A new booking system was introduced to manage the endoscopy booking system. The system allows to assign the no. of feasible slots to the medical team to schedule their cases at any point of time.It’s also facilitate to accommodate walk-inn patients during available open slots  time. It also helped to allow equal no. of distribution to all no.of attendings.

In 2016, the monthly avg. no show of endoscopy suite was 28%. After the implementation in Feb 2017, the no show for the year 2017 and 2018 came down to 24% and 20% respectively. There is a significant change in yearly no-show rate. This has also strengthened system’s booking capacity with increase of 67%. Hence, Booking was increase in 2017 and 2018 as compared to base year with 4.5% & 3.05% respectively. There is magnificent space created in system to accommodate walk-in patients any day as per the patient convenience as we have reduced walk-in cases from 47% in 2017 and 2018.

This process confirms the sustainability of the new appointment booking system. Findings showed that there is a significant decrease in number of no shows as we were able to capture them before time and other un-booked patients’ number has decreased, resulting in efficient utilization of resources. The staff will be working in a healthy environment with an equal distribution of work. Therefore, they will not be exhausted and get overburdened with delivering good quality care to patients. Lastly, an increase in the revenue will be beneficial for the department.

Biography:

Balwant Singh Gill has completed his MD from Dr. MGR Medical University, India. He is the Director of Swami Ji Gastroenterology Center (India) an Advanced Endoscopy Center. He has published more than 5 papers in reputed journals and has been serving as a consultant Gastroenterologist, Hepatologist & Interventional Endoscopist at their center of gastroenterology. He is also associated with few national and international associations.

Abstract:

Esophageal varices: Esophageal varices are dilated submucosal distal esophageal veins connecting the portal and systemic circulations. Th is happens due to portal hypertension (most commonly a result of cirrhosis), resistance to portal blood fl ow and increased portal venous blood infl ow. Th e most common fatal complication of cirrhosis is variceal rupture; the severity of liver disease correlates with the presence of varices and risk of bleeding.
Bleeding esophageal varices: No single treatment for bleeding Esophageal varices is appropriate for all patients and situations. An algorithm for management of the patient with acute bleeding is presented in this article. The options for long-term, defi nitive therapy and the criteria for selection of each are discussed.Pathophysiology and management of esophageal varices: Esophageal varices are one of the most common and severe complications of chronic liver diseases. New aspects in epidemiology, pathogenesis and treatment of varices are reviewed. Sclerotherapy is the fi rst-line treatment for acute hemorrhage. Prevention of first or recurrent bleeding is still unsatisfactory. β-Blockers are slightly superior to sclerotherapy with regard to prophylaxis of fi rst bleeding.β-Blockers or sclerotherapy may be used for prophylaxis of recurrent bleeding. However, prophylactic treatment regimens do not have a major impact on survival. Combination treatment, new drugs or new devices may help to improve the effi cacy of prophylactic measures. Endoscopic therapy for esophageal varices: Among therapeutic endoscopic options for Esophageal varices (EV), Endoscopic variceal ligation (EVL) has proven more eff ectiveness and safety compared with endoscopic sclerotherapynd is currently considered as the first choice. In acute EV bleeding, vasoactive therapy (either with terlipressin or somatostatin) prior to endoscopy improves outcomes; moreover, antibiotic prophylaxis has to be generally adopted. Variceal glue injection (cyanoacrylates) seems to be effective in the treatment of esophageal as well as in gastric varices. Prevention of rebleeding can be provided both by EVL alone or combined with non-selective β-blockers. Moreover, EVL can be adopted for primary prophylaxis, with no differences in mortality compared with drugs, in subjects with large varices and unfi t for a β-blocker regimen. A meta‐analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleeding: Despite publication of several randomized trials of prophylactic ariceal ligation, the effect on bleeding‐related outcomes is unclear. We performed a meta‐analysis of the trials, as identifi ed by electronic database searching and cross‐referencing. Both investigators independently applied inclusion and exclusion criteria and abstracted data from each trial. Standard meta‐analytic techniques were used to compute relative risks and the number needed to treat (NNT) for first variceal bleed, bleed‐related mortality and all‐cause mortality. Among 601 patients in 5 homogeneous trials comparing prophylactic ligation with untreated controls, relative risks of fi rst variceal bleed, bleed‐related mortality and all‐cause mortality were 0.36 (0.26‐0.50), 0.20 (0.11‐0.39) and 0.55 (0.43‐0.71), with respective NNTs of 4.1, 6.7 and 5.3. Among 283 subjects from 4 trials comparing ligation with β‐blocker therapy, the relative risk of fi rst variceal bleed was 0.48 (0.24‐0.96), with NNT of  13; However, there was no eff ect on either bleed‐related mortality (relative risk [RR], 0.61).

Biography:

Essam Soliman has completed his education from Fayoum University, Egypt. He has published 8 papers in reputed journals. Currently he is working as an Associate Director of GIT at Foyoum University. His research interest mainly lies in the fi elds of Topical Medicine and Liver.

Abstract:

Colorectal cancer (CRC) represented the second cause of mortality among cancer patients. Long noncoding RNAs and microRNAs (miRNAs) serve as non-invasive biomarkers for CRC surveillance and introduce new therapeutic approaches. LINC00657 and miR-106a expression levels play a pivotal role in CRC. Th is study included 190 Egyptian subjects and the expression levels of LINC00657 and miR-106a in serum were measured by using quantitative real-time polymerase chain reaction. We found that upregulation of LINC00657 and downregulation of miR-106a are signifi cantly associated with the development of CRC. Also, a positive correlation was detected between their serum levels. In addition, serum LINC00657 can distinguish adenomatous polyposis (AP) patients and/or ulcerative colitis (UC) patients from controls. Also the miRNA-106a expression level discriminates AP but not UC from healthy individuals. Our study cited new diagnostic biomarkers for CRC, AP and UC among Egyptians in addition to be non-invasive screening tools for CRC in both healthy subjects and those having precancerous lesions.

Biography:

Romain SCHMITT is a 3rd-year PhD student, and is currently working in the EA3452 CITHEFOR research unit (Nancy, France). He has for goal to have a post-doctoral position next year in a foreign country and to be an assistant professor. He has already published few papers with his colleagues, and is currently working on many papers that will be published in the incoming year.

Abstract:

Nitric oxide (NO) is known to play a pivotal role to maintain the intestinal barrier integrity, such as regulation of oxidative stress, healing, mucus secretion, immune system regulation, etc. S-nitrosoglutathione (GSNO), a nitric oxide donor is naturally secreted by enteric glial cells after stimulation of the vagus nerve. GSNO is known to prevent inflammatory events and to preserve intestinal barrier integrity [1][2]. We have highlight in a Ussing chamber model that there is a concentration-dependant effect of NO on rat ileon intestinal permeability: a low concentration of GSNO (0.1 µM) significantly decreases the permeability of sodium fluorescein after 2 hours when compared to high concentrations (100 µM). This effect is not observe in presence of glutathion equivalent concentrations. Moreover, GSNO degradation and absorption on isolated rat intestine were studied, and we found that an enzymatic activity of gamma-glutamyl-transpeptidase expressed on intestinal epithelioma (and also by microbiota [3]), is involved in GSNO intestinal permeability. Also, the inhibition of endogenous secretion of NO by using N-nitro-L-arginine methyl ester (NO synthases inhibitor) showed us that NO observed effect in intestinal permeability comes from exogenous supply with GSNO. From these results, GSNO could be proposed as an innovative prophylactic agent, in order to prevent relapses of inflammation for inflammatory bowel diseases patient in clinical remission.

Biography:

Nazar Omelchuk woks as abdominal surgeon at Ivano-Frankivsk regional hospital and at Ivano-Frankivsk national medical university. He is doing his PhD about minimally-invasive methods of acute pancreatic postnecrotic pseudocysts treatment. He has 3 registered patents about new ways of acute pancreatic postnecrotic pseudocysts treatment

Abstract:

STATEMENT OF THE PROBLEM: Acute necrotic pancreatitis (ANP) remains complicated problem of urgent surgery because of high frequency of systemic, purulent and septic complications, mortality rate, which is in patients with infected pancreonecrosis 14,7–26,4 %.

THE PURPOSE: The purpose of this study is to evaluate efficiency and establish indications for minimally invasive methods of treatment of postnecrotic pseudocysts of pancreas.

METHODOLOGY AND THEORETICAL ORIENTATION: For diagnostics were used ultrasonography, diagnostic laparoscopy, helical CT with contrast strengthening. Endoscopic interventions were applied by duodenoscopes “Olympus” under control of X-ray machine

“Siemens BV 300”. Cystodigestive fistulas were created by prickly papilotoms. For providing of long passability of cystodigestive fistula were used two endoprostheses like “pig tail” sized 10 Fr with length 5–6 sm. For transpapillary drainage were used pancreatic endoprostheses like “pig tail”, sized 5–7 Fr with length 5 sm.

FINDINGS: In 82 (68,2%) patients were applied minimally invasive methods of treatment. Percutaneous external drainage in 38 (46,3 %) patients, endoscopic transmural drainage of postnecrotic pseudocysts in 22 (26,85%) patients. Combined endoscopic interventions were applied in 22 (26,85%) patients. In particular, endoscopic transmural drainage with temporary stenting of pancreatic duct in 11 (50%) patients, endobiliary stenting with temporary stenting of pancreatic duct in 5 (22,7%) patients, temporary stenting of pancreatic duct in 4 (18,2%) patients, endoscopic transmural drainage with percutaneous external drainage in 2 (9,1%) patient.

CONCLUSION AND SIGNIFICANCE: Usage of combined minimally invasive methods of treatment of acute necrotic pancreatitis complicated by postnecrotic pseudocysts help to improve results of treatment, reduction of complications amount, contraction of stationary treatment terms and improving of life quality.

Biography:

Abstract:

We report a 59 year old man with controlled hypertension, diabetes mellitus and irritable bowel syndrome who was visiting surgical clinic for Per-rectal bleeding secondary to piles. He was referred for colonoscopy to rule out any other colonic pathologies. A colonoscopy was done on March 27, 2016 that revealed 2 small colonic polyps with no other mucosal pathology. Biopsy of one polyps showed tubular adenoma.

He started to have abdominal pain the 2^nd day post colonoscopy. This pain was dull aching moderate to severe associated with intermittent Per-rectal bleeding. The pain was attributed to Irritable Bowel syndrome (although this pain was different from the pain he used to have before) and the Per-rectal bleeding was attributed to piles.

Despite the fact that he was operated for piles 3 weeks later he continued to complain of abdominal pain with recurrent visits to Emergency room and Out-patients clinic.

 A repeat colonoscopy was done 3 weeks post operation to assess the cause for the continued abdominal pain and the Per-rectal bleeding. The 2^nd colonoscopy showed severe colitis involving upper sigmoid, descending colon and distal transverse with sloughed mucosa and black spots. The histology was consistent with ischemic colitis. He had chronic course with pain required recurrent admissions with conservative treatment, he refused surgical intervention. He improved very slowly. A third Colonoscopy with biopsy after 19 months showed completely normal mucosa with normal histology.

This case represents a rare cause of ischemic colitis precipitated by colonoscopy. The clinician should be aware of such scenario if patient continues to have unexplained abdominal pain post colonoscopy. There are few cases reported in the literature. No reported case from the kingdom.

Biography:

Abstract:

Background:  Iatrogenic biliary injuries are considered as the most serious complications during cholecystectomy. Better outcome of such injuries have been shown in cases managed in a specialized center.

Objective: Evaluatation of biliary injuries management in major referral hepatobiliary center.

Patients& Methods Four hundred seventy two consecutive patients with post-cholecystectomy biliary injuries were managed with multidisciplinary team (hepatobiliary surgeon, gastroenterologist and radiologist) at major Hepatobiliary center in Egypt  over 10 years period using endoscopy in 232 patients, percutaneous techniques in 42 patients and surgery in 198 patients.

Results: Endoscopy was very successful initial treatment of 232 patients (49%) with mild/moderate biliary leakage (68%) and biliary stricture (47%) with increased success by addition of percutaneous (Rendezvous technique) in 18 patients (3.8%). However, surgery was needed in 198 (42%) for major duct transection, ligation, major leakage and massive stricture. Surgery was urgently in 62 patients and electively in136 patients. Hepaticojejunostomy was done in most of cases with transanastomatic stents. One mortality after surgery due to biliary sepsis and postoperative Stricture was in 3 cases (1.5%) treated with percutaneous dilation and stenting.

Conclusion: Management of biliary injuries was much better with multidisciplinary care team with initial minimal invasive technique to major surgery in major complex injury encouraging for early referral to highly specialized hepatobiliary center.

Biography:

Abstract:

Background: The ideal management of cholecysto-choledocholithiasis is an open cholecystectomy (OC) with the CBD explorationworldwide. The single setting 2-stage approach- Endoscopic retrograde cholangiopancreatography (ERCP), sphincterotomy (EST), and common bile duct (CBD) clearance followed by laparoscopic cholecystectomy (LC)offers advantages, mainly by reducing the hospital stay and the morbidity.

Objective: To compare the ERCP+LCsingle setting approach with an OC with the CBD exploration for the treatment of cholecysto-choledocholithiasis.

Methods: We included the retrospective review of the open procedure which was maintained database from November 2012 onwards at our hospital and did a prospective study of the ERCP +LC procedure October 13 to October 2015 at Lumbini Medical College and Teaching Hospital, Palpa, Lumbini. The open cases were our control group. Patients with cholecysto-choledocholithiasis underwent 2-stage ERCP+LC in a single setting were compared with the 2-stage OC with CBD exploration in a single setting approach. All the cases included in the study are elective. The primary objective is to study the feasibility of the procedure, whereas secondary objectives are to 1) detect the morbidity (post-ERCP, Cholangitis, Pancreatitis, Abdominal collection, Wound infection), 2) the length of stay, and 3) stone clearance respectively. This is an interim analysis with the 83 patients in ERCP+LC and 77 in open group respectively.

Results: Hospital stay was significantly shorter in the ERCP+LC group; 3.92±0.719 days versus 10.30±1.557 days, P <0.05. There was significant difference in total morbidity of ERCP+LC group 7(8.4%) vs 14(18.2%), p-value<0.05, where wound infection in ERCP+LC group was 2(2.4%) vs 4(5.2%) and there was one case of abdominal collection1(1.2%) which was managed symptomatically. The incidence of retained CBD stone in ERCP+LC was 3(1.2%) which was managed successfully with ERCP. Post-ERCP amylase value was found within the normal limit in all the cases.

Conclusions: The analysis of our results suggestsERCP+LC in the settings of the peripheral hospital is feasible in terms of cost, length of hospital stay, morbidity and stone clearance.