Day 1 :
Keynote Forum
Vivian Florio Martini
Gastrica Usuy Medical Center and Dagostin Medical Center, Brazil
Keynote: Update on the diagnosis and treatment of pancreatic exocrine Insufficiency
Time : 9:00 am to 9:30am
Biography:
Italian - brazilian, I have been physician since 2005. I am specializing in geral surgey, surgery of system digestive and endoscopy. Titular Member of Brazilian Society of digestive system surgery and Brazilian Society of digestive endoscopy. Member of ASGE. Partner Asociación Española de Gastroenterología (AEG). Master of Advanced Endoscopy in Barcelona-Spain, University of Barcelona and Hospital Clínic. Training in Endoscopic Ultrasonography and EUS-guided Fine Needle Aspiration by Barcelona-Spain, Clínic Hospital.
Abstract:
Exocrine pancreatic insufficiency (EPI) characterized by a deficiency of exocrine pancreatic enzymes, resulting in an inability to properly digest food or poor digestion. Clinical manifestations of EPI are often nonspecific and can lead to lack of timely recognition and diagnosis. The etiology of this deficiency includes both pancreatic and non-pancreatic causes. The condition is associated with significant morbidity and reduced quality of life, even in milder forms.
Challenges in managing this condition include the nonspecific presentation of mild-to-moderate EPI and the lack of an accurate and convenient diagnostic test..
Inadequate digestion and fat malabsorption occur when intraduodenal lipase levels fall below 5– 10% of normal production. Early pancreatic disease, evident steatorrhea does not occur until approximately 90% of gland function has been lost. EPI manifestations are steatorrhea, malnutrition, deficiency of fat-soluble vitamins (A, E K, D) and trace elements, abdominal discomfort, bloating, weight loss and metabolic bone disease.
Symptoms are non-specific and are shared with other common gastrointestinal conditions. Many diagnostic tests are available to diagnose and have been classified as direct and indirect measures of exocrine pancreatic function. The gold standard has been 72-hour fecal fat test. The key of treatment is correctly use of PERT, stop smoking and alcohol consumption, consultation with a dietitian and a follow-up to ensure optimal treatment effect. A set of actions for normalize digestion, alleviate PEI symptoms and prevent malnutrition-related morbidity and mortality.
This review will summarize current concepts, diagnosis methods and treatment approaches using pancreatic enzymes for EPI.
Keynote Forum
Vignesh Balasubaramaniam
Queen Elizabeth Hospital King’s Lynn, United Kingdom
Keynote: Upper Gastrointestinal Bleed (UGIB); Hemospray, an essential tool in the Armamentarium
Time : 9:30 am to 10:00 am
Biography:
Dr Vignesh Balasubaramaniam, a 28 year old doctor, completed MBBS from Newcastle University and currently working in the department of General Surgery at Queen Elizabeth Hospital Kings’ Lynn.
Abstract:
Introduction:
Upper gastrointestinal bleed (UGIB) is a common presentation to the emergency department and accounts for approximately 50,000 - 70,000 admissions per year in the UK.Peptic ulcer disease (PUD) remains the most common cause of UGIB in the UK. Hemospray (Cook Medical, Winston-Salem, NC, USA) is an inert powder developed for endoscopic haemostasis. We aim to appraise the outcomes for UGIB where hemospray was used during the initial endoscopic therapeutic intervention.
Methods:
In this retrospective study from March 2018 to December 2020, cases of severe UGIB intervened with hemospray during primary presentation were identified via HICCS, an online database of endoscopy procedures. A detailed analysis of the demographics and outcome measures relating to the procedure, anatomical site of intervention, re-bleeding, and 30-day mortality were collected and interpreted.
Results:
20 patients with severe UGIB were identified, where hemospray was used to control the bleeding when other modalities such as Adrenaline injection, Endoclip and Gold probe application failed to stop the bleeding. Among this population, the mean age was 73 years, ranging between 61 to 98 years. There were 14 male patients (70%) in this cohort. Majority of the therapeutic intervention site was at the duodenum (n = 14) accounting for 70 % of the patients, followed by stomach in 25 % (n = 5) and oesophagus (n = 1) in 5%. Causes for the severe UGIB were duodenal ulcer in 12(60%), gastric ulcer in 2(10%), gastric malignancy in 2(10%), Dieulafoy lesion in 1(5%), metastatic duodenal tumour in 1(5%), Angiodysplasia in 1(5%) and severe reflux oesophagitis in 1(5%). Hemospray was successful in achieving initial haemostasis in all cases except in one case of massive haemorrhage with poor view of the bleeding site in duodenum where the bleeding could not be stopped. Following initial hemostasis, re-bleed occurred in 4 out of 19 patients (21%) who were then managed with best supportive care as treatment escalation was not considered appropriate due to comorbidity. 7 patients (35%) died within 30 days of the procedure out of which four occurred due to re-bleed and three patients died due to other medical causes.
Conclusions:
In our experience, Hemospray has proven to be an effective therapeutic intervention in achieving haemostasis in cases of severe UGIB when other endoscopic therapies fail to stop bleeding.
Keynote Forum
A. GUBBIOTTI
Humanitas Research Hospital, Endoscopy Unit,Italy
Keynote: Detection Rate of Sessile Serrated Lesions and Accuracy of Optical Biopsy as Quality Indicators
Time : 10:00-10:30
Biography:
Alessandro Gubbiotti achieved graduation in Medicine at the age of 24 years at University of Perugia. He then achieved specialization in Gastroenterology at University at Padua in 2021, at the age of 29, spending the last year as an Endoscopy Fellow at Humanitas Research Hospital (Rozzano), directed by Professor Repici. He currently work as a Medical Doctor at Padua Hospital
Abstract:
Relevant variability in terms of serrated detection performances was confirmed among endoscopists in the same patient population and centralized pathology. SL-DR should be upgraded as a key quality indicator of detection, and this also applies to optical biopsy for their characterization.
Keynote Forum
Abbas AliTasneem
Professor, Pakistan
Keynote: Utility of endoscopic ultrasound in the management of gastrointestinal tract related diseases: Experience from a tertiary care center in Karachi
Biography:
Abstract:
Introduction
Endoscopic ultrasound (EUS) is a useful diagnostic and therapeutic modality employed for the management of gastrointestinal (GI) tract related diseases particularly when percutaneous ultrasound is not as useful. The aim of this study was to share our experience regarding the utility of this important modality.
Methods
All patients undergoing EUS from September 2019 to December 2020 were included. Clinical characteristics of patients, indication for the procedure and outcome were recorded. The EUS equipment used was Pentax (linear and radial) sonoscopes. Biopsies were taken with FNA and FNB (Boston scientific and Cook) needles.
Results
A total of 309 patients underwent EUS (males159 (51.5%); mean age 48.1 ± 15.1 years). Majority of the procedures were linear 201 (65%) [vs radial 108 (35%)] and diagnostic 280 (90.6%) [vs therapeutic 29 (9.4%)]. Commonest indications were, diagnostic: biopsies 146 (52.1%), ruling out bile duct stones 51 (18.2%), staging of GI cancers 41 (14.6%); and therapeutic: drainage of peri-pancreatic fluid collection 18 (62.1%), abdominal pain relief 10 (34.5%). Commonest procedures among the sub-groups were: biopsies [pancreatic masses 45 (30.8%), mediastinal lymph nodes (LN) 32 (21.9), hepatobiliary LN 21 (14.4%), gastric wall masses 6 (4.1%)]; staging of cancers [esophageal 14 (34.1%), rectal 13 (31.7%)]; drainage procedures [pseudocysts 13 (72%), walled-off necrosis 5 (28%)]; pain relief [celiac block 7 (70%), celiac neurolysis (30%)]. Diagnostic yield of FNB was better than FNA needle, while samples drawn from mediastinal LN carried higher yield.
Conclusion
The main utility of EUS procedure in our set up is for obtaining biopsy of GI tract related masses, ruling out bile duct stones, staging of GI cancers, drainage of peri-pancreatic collections and abdominal pain relief. Diagnostic yield of mediastinal LN was better than pancreatic masses, while FNB needles drew better samples than FNA needles.
Keynote Forum
Mungwete Josue
Department of gastroenterology,Congo
Keynote: Screening for metabolic hepatic steatopathy by fibroscan, in type 2 diabetics in the Ivory Coast
Biography:
Mungwete Josue faculty in Department of gastroenterology, Panzi General Referral Hospital, Bukavu, The Democratic Republic of Congo
Abstract:
Metabolic hepatic steatopathy is a major public health problem. Type 2 diabetics have a significant risk of developing NAFLD with a higher morbidity and mortality rate than non-diabetic subjects. Fibroscan/ CAP is a good diagnostic and prognostic tool for metabolic steatopathy, the aim of this study was to screen for metabolic hepatic steatopathy by fibroscan/CAP in diabetic subjects in Ivory Coast. Materials and methods Descriptive and analytical cross-sectional study carried out from February 1 to August 31, 2020 in two medical structures in Abidjan. Included in the study were diabetic patients, aged at least 18 years, who had performed a fibroscan/CAP associated whith clinical, biological and morphological evaluation.
Results
We included 520 patents whose age was 51.3+/- years (range 28years and 71years) with a sex ratio of 0.62. The patients had hypertension in 56,6% of cases, insulin resistance in 53,8% of cases, a diabetic complication in 48.1% of cases and dyslipidemia in 17.3% of cases. The prevalence of hepatic steatopathy evaluated by fibroscan /CAP in diabetics was 53.8%, distributed as follows: 3.8% S1 steatosis, 34,6% S2 steatosis and 19.2% S3 steatosis. The prevalence of hepatic steatopathy evaluated by fibroscan/ CAP in diabetics was 53.8%, distributed as follows : 3,8% S1 steatosis, 34.6% S2 steatosis and 19.2% S3 steatosis.
The patients had insignificant fibrosis in 51% and moderate or severe fibrosis in 49.1%. The steatopathy of our patients was associated with arterial hypertension (p = 0,02), insulin resistance (p = 0,003), BMI greater than 28,8 (p = 0,02), an increase moderate ALT (p = 0,001) and GGT (p = 0,001). The only independent factor associated with steatopathy in our patients was elevation of GGT.
Conclusion : Metabolic hepatic steatopathy is common in type 2 diabetics in Ivory Coast; Fibroscan /CAP is a good diagnostic and prognosis for steatopathy and hepatic fibrosis in these patients.
Keywords : metabolic steatopathy, diabetes, fibroscan/ CAP, Sub-Saharan Africa