7^th Global Congress on Gastroenterology & Endoscopy September 12-14, 2016 Atlanta, Georgia, USA

Biography:

Amanda J Brisebois is an Internal Medicine and Palliative Care Specialist from Edmonton, Alberta, Canada. She has been practicing for 17 years, and has been focusing on the Integration of Palliative Care Principles in care of patients with chronic illness for the past 5 years. She is the current Facility Chief of Medicine at the Grey Nuns Hospital and also an Associate Clinical Professor at the University of Alberta. She has won numerous teaching awards, as well as grants to undertake her current work.

Abstract:

Background & Aim: Efforts are being focused on integrating palliative principles at the earlier stages of disease, and to create outpatient programs to focus on this type of integrated care.

Methods: To serve patients with cirrhosis, a non-cancer outpatient Palliative Care Clinic was formed and referral criteria were developed to make an attempt to capture patients in the last 6 months of life. ESAS-r (Edmonton system assessment scale) was attained for all the patients at each clinic visit. Data regarding their medication changes, goals of care, and stage of their disease, ER visits and hospitalizations were also recorded.

Results: In the outpatient clinic during 2013-2015, significant symptoms (score of 4 or more/10) were as follows: 70% pain, 90% fatigue, 60% drowsiness, 70% lack of appetite, 60% nausea, 40% shortness of breath, 30% depression and 40% anxiety. Patients had both compensated and de-compensated disease. KPS (Karnofsky Performance Status) average was over 60%, however, the death rate (30%) was high.

Conclusions: Analysis of the complete patient data for the initial 35 cirrhosis patients of the PPRISM clinic will be presented including information regarding referral success for various patient populations, symptom burden, goals of care documentation and follow up needs in this patient population. This study will guide future outpatient clinics by enhancing goals of care and advance care planning integration, patient and family involvement in health, and symptom care protocols for patients living with cirrhosis. A more detailed look at this data may also help future clinics to decide interdisciplinary needs of outpatients living with chronic illness.

Biography:

Kristie Briggs has received her ADN from Motlow State Community in Tullahoma, TN in 1999 and BSN from Middle Tennessee State University in Murfreesboro, TN in 2007. She is currently the Manager of Clinical Education for Erbe USA Inc., USA. She has worked as an Infection Control Coordinator and Chief Nursing Officer. She had published several continuing education booklets on Electrosurgery. She has provided many lectures to local/regional SGNA meetings around the country and also presented at the National SGNA.

Abstract:

Argon Plasma Coagulation™ (APC™) has been used in therapeutic interventional endoscopy since its introduction in 1992. In recent years, the range of clinical uses in endoscopy has expanded primarily due to the development of specialized modes and better techniques. APC can now offer individualized treatment options when combined with proper technique, enhancing desired tissue effects and optimize clinical outcomes. The history, advancements and where we are now; and the clinical benefits of APC in comparison to conventional electrosurgery will also be discussed. Clinical variables and safety considerations will also be covered along with APC’s ever-expanding role in therapeutic endoscopy.

Biography:

Sudha Kodali did her residency in Texas and her Fellowship at UAB in Gastroenterology and Hepatology. She is currently working as an Assistant Professor at UAB. She treats patients with liver diseases and her research interests include fatty liver, hepatitis C and granulomatous liver disease.  

Abstract:

We describe a young female with disseminated sarcoidosis presenting with refractory ascites. Sarcoidosis is a multisystem disease characterized by non-caseating granulomas of the liver and various other organs. Lungs are the most commonly involved organ systems. In about 70% patients, hepatic involvement can be seen, though only 10-30% of those actually have abnormal liver chemistry. Right upper quadrant pain, fatigue, jaundice and pruritis are the common presenting symptoms. Long standing complications include cirrhosis and sequelae of portal hypertension. Ascites can be secondary to cirrhosis/portal hypertension or cardiac/pulmonary hypertension. Peritoneal involvement can also lead to ascites even if liver is not involved. Liver biopsy shows non-caseating granulomas and imaging in the right clinical setting shows hepatosplenomegaly, low attenuation lesions in the liver and spleen. Differential diagnosis includes fungal infections (histoplasma, Mycobacterium), granulomatous liver disease (PBC (Primary Biliary Cirrhosis), PSC (Primary Sclerosing Cholangitis), malignancy. As most of the patients are asymptomatic, treatment is not needed in many. For the ones who need therapy, 1^st line agents are steroids and ursodiol. Itching can be disabling and the most challenging symptom to treat. In advanced liver disease, liver transplant may need to be considered. 0.0012% of all transplants in the USA are for sarcoidosis of the liver. Mortality rates have been reported between 1 to 5% usually from pulmonary, cardiac or CNS involvement.

Biography:

Dr.Vikas Leelavati Balasaheb Jadhav has completed Postgraduation in Radiology in 1994. He has a 19 Years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He has four Indian Patents & an International Patent published on his name in the field of Gastro-Intestinal Tract Sonography & the Radiology, since 2008. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 20 countries as an Invited Guest Faculty, since 2000. He is a Consultant Radiologist & the Specialist in Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

TransAbdominal Sonography of the Stomach & Duodenum can reveal following diseases. Gastritis & Duodenitis. Acid Gastritis. An Ulcer, whether it is superficial, deep with risk of impending perforation, Perforated, Sealed perforation, Chronic Ulcer & Post-Healing fibrosis & stricture. Polyps & Diverticulum. Benign intra-mural tumours. Intra-mural haematoma. Duodenal outlet obstruction due to Annular Pancreas. Gastro-Duodenal Ascariasis. Pancreatic or Biliary Stents. Foreign Body. Necrotizing Gastro-Duodenitis. Tuberculosis. Lesions of Ampulla of Vater like prolapsed, benign & infiltrating mass lesions. Neoplastic lesion is usually a segment involvement, & shows irregularly thickened, hypoechoic & aperistaltic wall with loss of normal layering pattern. It is usually a solitary stricture & has eccentric irregular luminal narrowing. It shows loss of normal Gut Signature. Enlargement of the involved segment seen. Shouldering effect at the ends of stricture is most common feature. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-Ampullary malignancy or distant metastasis. All these cases are compared & proved with gold standards like surgery & endoscopy.

Some extra efforts taken during all routine or emergent ultrasonography examinations can be an effective non-invasive method to diagnose primarily hitherto unsuspected benign & malignant Gastro-Intestinal Tract lesions, so should be the investigation of choice.

Biography:

Inga Peter has completed her PhD in Genetic Epidemiology from Tel Aviv University, Israel and Post-doctoral studies from Tufts University, Boston. She is an Associate Professor in the Department of Genetics and Genomic Sciences at the Icahn School of Medicine at Mount Sinai, New York. She has published over 100 papers in reputed journals and served as a Reviewer on numerous panels. She has significantly contributed to the field of IBD by establishing a large bio-bank of IBD patients with over 4,000 DNA, tissue and stool samples linked to extensive clinical data and by leading numerous genetic and microbiome studies.

Abstract:

Crohn’s disease (CD) and ulcerative colitis are inflammatory conditions, collectively referred to as inflammatory bowel disease (IBD), which results from defects in the regulation of mucosal immune responses to enteric bacteria in genetically susceptible individuals. Multiple lines of evidence suggest a genetic contribution to the pathogenesis of IBD, which include racial and ethnic differences in disease prevalence, familial aggregation and link to other genetic syndromes. Recent genome-wide association studies (GWAS) have identified >200 genetic variants associated with IBD risk, some of which have functions in biological pathways of pathogen recognition, internalization and autophagy. However, GWAS-identified loci have explained less than a quarter of the heritability estimated for IBD and many are confined to noncoding regions, requiring further studies to understand their role in disease pathogenesis. Recently, next generation sequencing efforts, most successful in isolated populations and individuals with early age of onset and/or significant family history of IBD, identified rare coding variants associated with IBD risk that are more amenable to functional studies than GWAS loci. Also, a number of genetic variants have been linked to adverse events resulting from IBD therapies, particularly thiopurine exposure, including bone marrow toxicity and pancreatitis. Yet, despite substantial progress in the field of genetics and genomics of IBD, reliable tools to identify individuals at risk, determine disease progression and predict response to therapies are still lacking. More comprehensive approaches that incorporate clinical, genetic, epigenetic, metabolomic, and microbiome data need to be developed to allow for an early diagnosis and personalized treatment for IBD.

Biography:

Senior Consultant at Med. II Horst Schmidt Klinik Wiesbaden. Obtained PhD during 01/2012  Habilitation in the field of diagnostic methods of gastrointestinal endoscopy at University of Mainz.

Abstract:

Today there is a paradigm shift in modern gastrointestinal endoscopy, whereby the aim of modern endoscopy is to identify premalignant conditions and early neoplastic changes, in order to make a therapeutical impact on their natural history.

Computer chip and endoscopic image enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal tract, supplying clinicians with information that complements conventional white-light endoscopy. This is important due to the fact, that the prognosis of patients with malignancies in the gastrointestinal tract is strictly dependent on early detection of premalignant and malignant lesions. Equipped with this information, endoscopists can obtain today in vivo optical diagnosis of lesion histology at the time of the endoscopic procedure to help to identify subtle mucosal and structural changes that harbour precancerous cells.

Based on that fact also the development of new and effective endoscopic therapies means that neoplastic lesions can now be treated with improved patient outcomes.

Looking on the available imaging modalities, each with implications on cost, training and lesion detection, we describe in this review the scientific rationale behind the major commercially available techniques as well as offering a glimpse at possible future directions.

Biography:

Milagros Pichardo, MD finished her medical training in 2009 from Universidad Nacional Pedro Henriquez Urena. Currently she is in her second year of Internal Medicine Program at Damas Hospital in Ponce, PR, USA.

Abstract:

Amyloidois is the term for a group of protein folding disorders characterized by the extracellular deposition of insoluble polymeric protein fibrils in tissues and organs. Amyloidosis is commonly systemic, occasionally organ-limited, and rarely a solitary localized mass. This latter presentation is commonly referred to as tumoral amyloidosis. Although reports exists of these often called “amyloidomas” showing up in almost every tissue/organ, the GI tract has a prevalence that is not well document making it an outstanding diagnostic challenge. A 66 year-old male with a history of IV drug abuse, comes to our hospital to be evaluated due to diarrhea that started 2 months ago; 3-5 depositions a day, watery in consistency no blood or mucus, associated with epigastric abdominal pain described as “burning” in nature, 7/10 intensity without radiation and a 50 pound weight loss. Denied fever, chills, shortness of breath, nausea or vomiting; symptoms were non consistently worsened with food ingestion and did not improve with OTCmedication for diarrhea. PMH was significant for HCV diagnosed 1 month ago. On physical exam the abdomen showed a prominent liver edge 5cm below the costal margin non tender, non-distended without ascites. Laboratory work-up upon admission showed metabolic acidosis, acute kidney injury, no electrolyte disturbances and an elevated TSH. Esophagogastroduodenoscopy (EGD) done the day after admission showed an esophagus that was normal and a friable mass in the antrum of the stomach that bled on contact, cold forceps biopsy was taken. A colonoscopy was also performed, with unremarkable findings; random biopsies taken. Pathology reports a tissue that on red Congo stain has apple-green birefringence indicative of amyloid fibrils in both colonic and gastric samples. The deposition of amyloid fibrils in other organs were sought out with negative results; thus giving the impression of single system involvement. Gastrointestinal amyloidosis causes severe malabsorption due to the deposition of the protein fibrils, explaining the patient’s chronic diarrhea and significant weight loss.  Since patient’s malabsorption caused wasting and malnourishment, total parenteral nutrition was indicated while the patient received chemotherapy for the treatment of amyloidosis. This case illustrates that there is an important risk of misunderstanding and diagnosis delay of patients that present with malabsorption. Even if the clinical symptoms are not obvious upon initial presentation, the hypothesis of gastrointestinal amyloidosis should be considered among the possible diagnosis of patients with chronic diarrhea and weight loss. In doing so, quality of life as well as morbidity improvement should be evident

Biography:

Will be updated soon

Abstract:

Intestinal carcinoid tumors are uncommon malignancies which grow slowly, and rarely cause any symptoms. Small bowel tumors can, at times, cause bowel obstruction and rarely bleeding. We present to you a 52 year old male who presented to the hospital for evaluation of melena. His endoscopy and colonoscopy came back negative and patient unfortunately, failed to get capsule endoscopy as an outpatient. One year later, patient presented with excruciating abdominal pain and was found to have small bowel obstruction with multiple transition points. Patient was found to have 4 nodular lesions in the small intestine which were found to be carcinoid tumor. Surgical resection definitely improved his outcome and patient did not need adjuvant therapy post-surgery. This patient was a diagnostic challenge due unusual presentation and negative CT scan imaging during both presentations. Carcinoid tumors are highly infiltrating tumors hence, high degree of suspicion should be kept for earlier detection and better outcome.