Day 2 :
- Gastroenterology
Session Introduction
Romain SCHMITT
University of Lorraine,France
Title: Nitric oxide donor, S-nitrosoglutathione, to maintain intestinal barrier integrity: potential therapeutic candidate for prevention of inflammation recurrences.

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.
Nazar Omelchuk
Ivano-Frankivsk national medical university, Ukraine
Title: Minimally-invasive methods of acute pancreatic postnecrotic pseudocysts treatment

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.
Wadha R.AlSubaiee
National Guard Hospital. Al Ahsa |Eastern region| Saudi Arabia
Title: Ischemic colitis as a rare complication of colonoscopy

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 2nd 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 2nd 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.
- Gallbladder and biliary tract Diseases
Session Introduction
Ibrahim Abdelkader Salama
Menophyia University, Egypt.
Title: Iatrogenic biliary injuries: Multidisciplinary Management in a Major tertiary Referral center

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.
Assoc Prof Dr.Nabin Pokharel1
Lumbini Medical College and Teaching Hospital,
Title: ERCP and Laparoscopic cholecystectomy as a single setting procedure, can it be done safely in peripheral rural hospital

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.