14^th Annual Congress on Gastroenterology & Hepatology August 6-7, 2018 Hyatt Regency Osaka, Japan

Biography:

Luis Fernando Sandoval graduated of general medicine from Universidad de San Carlos de Guatemala (San Carlos University of Guatemala), with a master degree, cum laude and chief of residents in Internal Medicine at IGSS. He works as Internal Medicine Attending Physician in the same institute, and as professor in Universidad Francisco Marroquin (Francisco Marroquin University). Locally he has published researches about gastric cancer, esophageal varices, cirrhosis and HCC.  He has showed the first epidemiological formal evidence of the non-cirrhotic HCC at IGSS and Guatemala. The recent data of HCC has opened the curiosity of international researches for seeking the etiology of these neoplastic lesions.         

Abstract:

Statement of the Problem: Guatemala has the highest incidence and mortality of hepatocarcinoma (HCC) in Latin America and the Caribbean in both sexes. This liver neoplasm is the 7^th cause of cancer in Central America, and the 2^nd cause of incidence and cancer mortality in Guatemala. (Cancer Today, 2012)  There are many risk factors already identified, in the indisputable first place is cirrhosis, then HBV (chronic and carrier), HCV, alcoholism, NAFLD etc. (NCCN, 2018). Only about 10% of HCCs develop in non-cirrhotic livers (Tiffany Hennedige, 2012). In every day medical practice, we have seen an increase in non-cirrhosis HCC, with no other traditional risk factors. It woke up our curiosity and interest to characterize our hepatic cancer. Methodology & Theoretical Orientation: Observational, retrospective and analytic study.  All HCC attended at IGSS in 2015 – 2016 were analyzed, researching for epidemiological data, focusing in differences between cirrhotic vs. non-cirrhotic patients. Statistical analysis was performed with PSPP 2007. Categorical variables were presented with frequency and percentages, and analyzed by chi squared of homogeneity. Normality was tested with Kolmogorov-Smirnov. Numerical data were evaluated with t-student of independent samples. At relational level a bivariate study was made, then elevated to multivariate level. Findings: Total of 53 HCC cases were found, 15 cirrhotic and 38 non-cirrhotic (71.69%). Comparing both groups, there is no statistical difference between age, BMI, sex, family history of cancer, alcoholism, tobacco, diabetes mellitus, obesity, HBV, HCV, AFP, mass diameter, nor treatment (surgery, TACE, radiofrequency and sorafenib). There is difference in jaundice, ascites and encephalopathy, possibly due the same cirrhosis. It should be emphasized the importance of the high number of HCC in apparently healthy livers, contrasting global epidemiology. Staring with this new revealing knowledge we must analyze our medical approach to diagnose and manage HCC in Guatemala, and look for our nontraditional risk factors.    

Biography:

Abstract:

Introduction:

Inflammatory bowel diseases (IBD) are a group of chronic diseases of the bowels which have unknown aetiology. Reports indicate that prolonged inflammation leads to the damage of the GI tract. There are two major types of IBD; namely, Crohn’s Disease abbreviated as CD and Ulcerative Colitis abbreviated as UC.   With studies having established that there is a link between diabetes and IBD, this study sought to investigate if there was any relation between blood glucose level (glyceamic changes) and remission in patients with IBD. This study examined a number of factors such as the blood glucose levels of the patients and histology among others.  The experimental phase of this study divided the participants into three as described in the study sampling including a control group. This section presents the study methodology that includes the ethical concerns, the study design, the sampling of the participants, the procedure followed during data collection, and the statistical data analysis plan. Study Aim:The main aim of this study is to monitor the glycaemic status of IBD patients during the remission and flare-up. The study will investigate if there is any relation between blood glucose level and remission in patient with IBD. The hypothesis is glucose status is abnormal in active inactive IBD.Methodology:A cross-sectional study determines exposure and outcome simultaneously for every subject.  The studies have been regarded as the most appropriate for screening hypothesis for the reason that they require a comparatively shorter time commitment as well as fewer resources to undertake.  The total numbers of sample employed in this study was 160. The study participants were classified into three groups. The first group included the patients with IBD in remission while the second group comprised of the patients who are experiencing flare up. The third group comprised of normal subjects who were equally described as the control group. The inclusion criteria for the participants in this study included age that encompassed 16-90 year-old, the medical condition of the patient where the ones included were known to have IBD, and the patients under gastroenterology team at University Hospital of South Manchester. . The exclusion criteria for a subject to be removed or not allowed to take part in this study were pregnancy.  In this research, the software SPSS version 20 was used to analyse the data. The relationship between study variables was equally examined using the Chi-Square test, and independent T test. Study hypothesis was examined using One Way Anova Test. Regression analysis was also used to identify predictors of IBD. Significance was considered at alpha level <0.05.Results:The total number of participants in this study were 160 whose medical records were analysed as well as tests conducted for various indicators of IBD disease on their blood samples. 57% of 91 participants were female (57%) while 69 participants were male (43%). Out of this population, 68% were aged 40years and above while 32% were below 40 years of age. This indicates that Inflammatory Bowel disease (IBD) affects mostly people above 40 years of age. The Montreal classification type A2L1B1 (8.1%) L1- location Ileocolonic and B1-inflammtory behaviour was lower compared to 16% of E1S0. This indicates that most IBD patients are in this category of Montreal classification. There are no significant statistical differences seen in the other disease types. The other Montreal classification category A2L2B2 [16%] equally had a high percentage in diabetes patient but found to have no statistical difference between other Montreal classifications. 

A1L1B1 Montreal classification category participants has the least relationship with diabetic patients (0.6%).Conclusion:In conclusion, the principal aim of this study is to monitor the glycaemic status of IBD patients during the remission and flare-up.  The chi-square of age and sex indicated a variance of 1.55. And (p<0.05). This shows that there is no significant difference between age and sex hence most people are affected by IBD. This thus rejects the null hypothesis and accepts alternative hypothesis that states that there is a relationship between glycaemic status of IBD patients during the remission and flare-up. The hypothesis also proves that there is a relation between blood glucose level and remission in patient with IBD. 

Biography:

Abstract:

Brain stem syndrome is a condition commonly characterized by limb weakness,ophthalmoplegia and gait disturbances. The common causes of brain stem syndrome are ischaemia, neoplasia, demyelination, infection and hamartoma type lesions in the brain. Imaging ideally with a MRI scan is usually diagnostic in most cases. CSF study helps in identifying the cause in most cases.A 42 yr old caucasian lady presented with non-specific symptoms like lethargy, malaise, was off food for a couple of months and had lost a considerable amount of weight (4 stones = 25.4kgs). She was admitted to the hospital with nausea and vomiting for a few weeks and complained of a lump in her throat.Gastroscopy was unremarkable. She also complained of sudden onset of double vision for the last few days and examination showed vertical Nystagmus.

She also complained of unusual sensation in her feet and soreness in the bottom of her feet when she stood up. There was no obvious limb ataxia, absent lower limb tendon jerks but flex or plantars and intact objective peripheral senses.Gait was unsteady while walking with eyes open but was better with eyes closed.The patient was lucid the whole time. During the course of the stay in the hospital the patient developed Oscillopia. She underwent a MRI scan which was unremarkable. She was investigated for autoimmune cause including GQ1b for miller fischer syndrome and Paraneoplastic screen to investigate the weight loss.Lumbar puncture which was performed which showed protein of 0.69 and rest of the values are normal. She was transferred to a tertiary neurology centre.Based on her clinical examination finding and MRI report she was diagnosed with brain stem syndrome secondary to malnutrition due to functional dyspepsia. She was seen by the dieticians and NG feed was started.

Biography:

Dr Amit Sen is a consultant Physician in Medicine at St Mary's Hospital Newport UK with over 20 years clinical experience. He has taken part in multiple clinical trials, and has written dissertation on percutaneous tracheostomy and is keen in teaching junior doctors and medical students.

Abstract:

Brain stem syndrome is a condition commonly characterized by limb weakness,ophthalmoplegia and gait disturbances. The common causes of brain stem syndrome are ischaemia, neoplasia, demyelination, infection and hamartoma type lesions in the brain. Imaging ideally with a MRI scan is usually diagnostic in most cases. CSF study helps in identifying the cause in most cases.A 42 yr old caucasian lady presented with non-specific symptoms like lethargy, malaise, was off food for a couple of months and had lost a considerable amount of weight (4 stones = 25.4kgs). She was admitted to the hospital with nausea and vomiting for a few weeks and complained of a lump in her throat.Gastroscopy was unremarkable. She also complained of sudden onset of double vision for the last few days and examination showed vertical Nystagmus.She also complained of unusual sensation in her feet and soreness in the bottom of her feet when she stood up. There was no obvious limb ataxia, absent lower limb tendon jerks but flex or plantars and intact objective peripheral senses.Gait was unsteady while walking with eyes open but was better with eyes closed.

The patient was lucid the whole time. During the course of the stay in the hospital the patient developed Oscillopia. She underwent a MRI scan which was unremarkable. She was investigated for autoimmune cause including GQ1b for miller fischer syndrome and Paraneoplastic screen to investigate the weight loss.Lumbar puncture which was performed which showed protein of 0.69 and rest of the values are normal. She was transferred to a tertiary neurology centre.Based on her clinical examination finding and MRI report she was diagnosed with brain stem syndrome secondary to malnutrition due to functional dyspepsia. She was seen by the dieticians and NG feed was started.

Biography:

Dr, Adeyemi Abati completed is MBBS in 2004 at obafemi awolowo university teaching hospital ile –ife  Nigeria, he was trained at the department of inectious diseases during is residency. and he was able to provide several superior care and consultaion that resulted in overall improvement of department patient’s satisfation quotient.Dr Adeyemi focused on patient’s treatment and re-evaluated several methods of therapy management dependant on infection types tailored to patient’s individual patient history and efficacy of previous treatments.Dr, Adeyemi latter preceded and completed is master degree in public health at the same institution.Dr Adeyemi has then been practicing in department of infectious disease at Lagos university teaching hospital, one of the top tree infection disease hospital in Nigeria and also doing his Phd at the moment .Dr, Adeyemi currently holds a certification from Nigerian board of internal medicine for internal medicine ,hematology and infectious disease and also awarded the ward of the developing leader in medicine from Nigerian medical association in 2010 for his excellent contribution in general treatment and towards the reduction of infectious disease in Nigeria.

Abstract:

Aims : In Nigeria, hepatitis c virus (HCV) infection is primarily spread through injection drug use. there is an urgent need to improve access to care for HCV among persons with opioid  use disorders who inject drugs. the purpose of our study was to determine the prevalence of HCV, patient characteristics, and receipt of appropriate care in a sample of patients treated with buprenorphine for their opioid use disorders in a primary care setting.Methods : This study used retrospective clinical data from the electronic medical record. the study population included patients receiving buprenorphine in the office based opioid treatment (obot) clinic within the adult primary medicine clinic at Lagos medical center between October 2008 and august 2015 who received a conclusive hcv antibody ab test within a year of clinic entry. we compared characteristics by HCV serostatus using pearson's chi-square and provided numbers/percentages receiving appropriate care.Results : The sample comprised 300 patients. slightly less than half of all patients (n = 134, 27.7%) were HCV ab positive, and were significantly more likely to be older hausas and yoruba’s, have diagnoses of post- traumatic stress disorder (Ptsd) and bipolar disorder, have prior heroin or cocaine use, and be HIV- infected. among the 134 Hcv ab positive patients, 126 (67.7%) had detectable Hcv ribonucleic acid (RNA) indicating chronic HCV infection; only 8 patients (2.21%) with chronic hcv infection ever initiated treatment.Conclusions : Nearly half of patients (47.7%) receiving office-based treatment with buprenorphine for their opioid use disorder had a positive hepatitis c virus antibody screening test , although initiation of HCV treatment was nearly non- existent (2.21%).

Biography:

Abstract:

Four species of bifidobacteria were studied for growth, acid production; bile acids tolerance and adherence to sheep epithelial cells were studies. The species examined were Bifidobacterium longum ATCC 15707, B. bifidum ATCC 2203, B. angulatum ATCC 2238 and B. breve ATCC 2258 were tested for growth and environmental conditions. The log phase of B.longum and B.angulatum were found to be after 14h phase whereas the log phase of the other two species were found to be after 17h of inoculation. Both B.longum and B.angulatum reduced the pH  faster than both B.bifidum and B.breve.

B.longum had the highest growth and B.breve had the lowest growth rate. All the studied species exhibited some degree of bile tolerance. B.longum and B.bifium were more resistant to bile acids than the other two species. Adhesion of the four species to the columnar epithelial cells of the small intestine of sheep was studied. All the tested species showed some degree of adhesion, however, B.longum adhered to the epithelial cells more than other three species.

Biography:

Longxin Qiu has completed his PhD at the age of 38 years from Xiamen University. He is the dean of school of life sciences, Longyan University. He has published more than 20 papers in reputed journals and has been serving as an editorial board member of World Journal of Hepatitis, etc.   
 

Abstract:

Fatty liver disease (FLD) is a growing public health problem worldwide. The requirement for alternative and natural medicine has been increasing rapidly and considerably. Recently aldose reductase (AR)/polyol pathway has been reported to be involved in the development of FLD, therefore it is of interest to study the effect of plant-derived AR inhibitors on FLD. By conducting some investigations and by reading through literatures regarding AR inhibitors and FLD, we propose that plant-derived AR inhibitors may block AR/polyol pathway and in turn reduce the fructose production and the subsequent fat accumulation in liver in diabetic or high glucose diet-fed mice. Moreover, we propose that in rodents with alcoholic liver disease or nonalcoholic fatty liver disease/nonalcoholic steatohepatitis, AR inhibitors may improve PPARα-mediated fatty acid oxidation and reduce hepatic steatosis, and may attenuate CYP2E1-mediated oxidative stress or AR/gut bacterial endotoxin-mediated cytokines overproduction to alleviate progression of FLD. We conclude that potent AR inhibitors of plant origin may be efficient drugs for the treatment and prevention of FLD.

Biography:

Abstract:

Multiple myeloma (MM) is a malignant proliferation of plasma cells that secrete monoclonal immunglobin (M protein). It accounts for 1% of all cancers and 10% of hematological malignancies. Mean age at diagnosis is 66 years. The most common findings are bone pain, pathological fractures, anemia, bone marrow failure, Infections triggered by neutropenia and immunodeficiency, and kidney failure and rarely can cause acute hypercalcaemia, symptomatic hyperviscosity, neuropathy, amyloidosis and coagulopathy.Amyloidosis is a rare disease characterized by nonspecific symptoms and signs. It can be seen anywhere in the gastrointestinal tract.A 76-year-old female patient with multiple myeloma was directed to gastroenterology with rectal bleeding while hospitalized with acute renal failure and hypercalcemia. The patient underwent colonoscopy. and lumen-narrowing, vegetan, erosional, moderately hard, pseudotumor-like, muco-pleural lesions were detected at approximately between 50-60. cm on colonoscopy. There was partial narrowing and pseudotumor in the colon. Six different biopsies were taken from different places on lesions. Homogenous, amorphous material accumulation in the submucosa and around the veins were detected in the biopsy specimens stained with hematoxylin and eosin dye and Congo red. The patient underwent a second colonoscopy 1 month later for control. The lesions detected in the first colonoscopy were not found. On the second colonoscopy, biopsy was taken again from the rectosigmoid region, but it has been observed that the amyloidosis continues in biopsy.In this case, a colonoscopy was performed on the patient who was directed to gastroenterology clinic with rectal bleeding and amyloidosis was detected in the biopsy from tumoral lesions seen in the colonoscopy. 

Biography:

Dr Tanuja Mallik is a consultant gastroenterology and liver transplant anesthesiologist working with Dr Vivek Vij team in Fortis Escorts Hospital, New Delhi, India for last two year. She has been involved in liver transplant, as anesthesiologist since 2010. She provides extensive top-notch care with the team for a wide span of gastrointestinal, pancreatic and liver conditions. She prides in providing compassionate care with primary focus on patient satisfaction.

Abstract:

Statement of the Problem: Sickle cell disease can lead to hepatic complication ranging from acute hepatic crisis to chronic liver disease including intrahepatic cholestasis and iron overload. There are few case reports of orthotopic liver transplant in patient with sickle cell disease. Its quite challenging but feasible.  Methodology & Theoretical Orientation: Data regarding liver transplant in sickle cell hepatopathy is limited. Although it has been proposed on a case by case basis, only a few case series with a total of 18 cases where orthotopic liver transplant was performed has been reported. Findings: A common observation among all these liver transplant patients was that efforts to maintain HbS < 25%­30% by red cell exchange and hemoglobin level 8­10 g/dL were associated with improved post­transplant survival. Even post­transplant liver grafts are at increased risk of vascular thrombosis and graft failure as well as risk of infection due to multiple transfusion. Outcome in these patients can be improved, if the neurological complication can be minimized.

Biography:

Degree in Medicine and Surgery and Specialties in "Gastroenterology" and "Internal Medicine" at the University of Rome.1980-1983 University of Los Angeles (USA), he is interested endoscopic sclerosis of esophageal varices and retrograde cholangiopancreatography-endoscopically.University Professor - Chair of Gastroenterology - University of Rome.Head of the Digestive Endoscopy Service of the University Hospital Umberto I in Rome.Professor of "Endoscopy" and "Digestive System Diseases" at the Faculty of Medicine, University of Rome - "La Sapienza."Lecturer in E.C.M. Courses (Continuing Medical Education), national and international.Expert of the Ministry of Health for Gastroenterology.

Abstract:

The main cause of portal hypertension and of the formation of esophago-gastric varices is cirrhosis of the liver. The prevalence of cirrhosis has been estimated at around 0.15% in the United States, with data that are substantially similar in Europe, with even higher numbers in most African and Asian countries (where chronic viral hepatitis B or C are common). Another cause of portal hypertension is schistosomiasis, affecting 200 million people worldwide. Right heart failure, pericarditis, Budd-Chiari syndrome, inferior caval thrombosis, extra-hepatic tumors (biliary tract, pancreas, stomach, retroperitoneum) cause portal hypertension.

From the point of view of the Endoscopist Gastroenterologist, the main complication of this syndrome is digestive haemorrhage, which is also the main cause of death of the cirrhotic patient and of the patient with portal hypertension.In this presentation, I report the methods to diagnose this disease, with particular reference to the calculation of the risk of bleeding, and the therapeutic techniques of prophylaxis and therapy of the acute event.

Biography:

Lem Edith Abongwa  a Medical Microbiologist  is an assistant lecturer of the University of Bamenda and a PhD student in Kenyatta University..  My research interest is on HIV and Hepatitis B virus. I am interested in the identification and assessment of risk factors that expose communities to these infections and possible solutions to prevent and control them as well as  parasite strain diversity and severity to infectious infection. Prior to medical research she was the head, a public health non-governmental organization assessing the implementation of option B+ in two regions of Cameroon sponsored by a PEPFAR HIV/AIDS project in Cameroon

Abstract:

Aims/Purpose: Hepatotoxicity due to highly active antiretroviral therapy (HAART) has gained prominent attention since it can be affected by many factors. The aim of this study was to determine the prevalence of hepatotoxicity and related risk factors of severe hepatotoxicity following HAART initiation.Methods: One hundred naive HIV-1 patients were recruited and followed up for 24 weeks. They were placed on either Tenofovir(TDF)+Lamivudine(3TC)+Efavirenz(EFV) or Zidovudine(AZT)+Lamivudine+Nevirapine(NVP) or  Zidovudine+Lamivudine+Efavirenz regimen. Venous blood samples were collected to measure transaminotransferases (ALT and AST) and alkaline phosphatase (ALP), using colometric enzymatic reaction which were used to classified hepatotoxicity based on age and sex.Results: A total of 38(38%) and 55(55%) patients presented with hepatotoxicity while 15% and 28% of patients of them had severe hepatotoxicity at 4 and 24 weeks respectively. Serum levels of all enzymes increased significantly (p<0.05) with increased treatment duration. Univariate analysis revealed that the risk factor of developing severe hepatotoxicity was significantly (p<0.05) greater in patients <30years, males, low BMI, low monthly income earners and patient on AZT+3TC+ NVP regimen. While multivariate analysis showed that age <30 years, Low BMI, low monthly income and the use of AZT+3TC+NVP was an independent risk factors.Conclusions:  Low BMI, <30years, low monthly income and the use of AZT+3TC+NVP regimen were identifiable risk factors  for the development of severe hepatotoxicity. As such these factors should be considered as an important strategy by clinicians in preventing the hepatotoxicity.

Biography:

Sheryl Lim is a Year 4 Medical Student in Cardiff University, United Kingdom. This project in Neuroendocrine Tumours was part of my year 3 Student Selected Component (SSC), and was done alongside Dr Mohid Khan, (Consultant in Gastroenterology and Neuroendocrine Tumour and Clinical Lead of the Welsh Neuroendocrine Tumour Service)

Abstract:

Introduction:NETs have diverse natural history and clinical syndromes. As a result of the disease or related to management, patients may have altered gut or pancreatic function that can cause nutritional deficiencies. There is a lack of consistent evidence-based dietetic guidance for patients with NETs.Aim:This study evaluated whether nutritional status and nutritional deficiencies had been assessed in patients with NETs in an existing service in South Wales.Method:A retrospective study included 141 NET patients seen in Gastroenterology (n=74) and Endocrinology (n=67) clinics. Key parameters collected were: BMI, weight, vitamin B12, Ferritin, Folate, Albumin, vitamins A/D/E and presence of steatorrhoea. Evidence of treatment with vitamin or iron replacement and use of bile acid sequestrants or Creon was also recorded.Results :Weight was recorded in under half of patients (n=70) and BMI in just 14% (n=20). 54 patients reported weight loss, 70% of these (n=38) had a quantified weight loss, 46% had percentage weight loss calculated.106 patients (75%) had been investigated for a form of vitamin or iron deficiency. The likelihood of investigation was significantly higher in Gastroenterology clinic patients than Endocrine clinics (95% vs. 54%, p<0.01). 57% of those investigated were found to have a deficiency, which was consistent across specialities: 59% (41/70) of those from Gastroenterology clinics and 53% (19/36) from Endocrine clinics. 41/60 patients (68%) with a recorded deficiency did not have sufficient replacement. 7/27 patients with iron deficiency were given supplementation. 38 patients had vitamin D levels tested (27%), 29 were insufficient (76%).27 patients reported steatorrheoa, 26 of whom were prescribed somatostatin analogues. 96% of these patients were also prescribed Creon.Conclusion :Although higher rates of nutritional assessment were found in patients who had been assessed by Gastroenterology and with gastro-specialist dietetic involvement, assessment and management of nutritional status in patients with NETs remains an unmet need.

Biography:

Dr.Vikas Leelavati BalaSaheb Jadhav has completed PostGraduation in Radiology in 1994. He has a 23 Years of experience in the field of Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonography. He is the Pioneer of Gastro-Intestinal Tract Sonography, especially Gastro-Duodenal Sonography. He has delivered many Guest Lectures in Indian as well International Conferences in nearly 27 countries as an Invited Guest Faculty, since March 2000. He is a Consultant Radiologist & the Specialist in Conventional as well Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

TransAbdominal Sonography of the Small & Large Intestines can reveal following diseases. Bacterial & Viral Entero-Colitis. 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. Intestinal Ascariasis. Foreign Body. Necrotizing Entero-Colitis. Tuberculosis. Intussusception. Inflammatory Bowel Disease, Ulcerative Colitis, Cronhs Disease. Complications of an Inflammatory Bowel Disease – Perforation, Stricture. 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. Primary arising from wall itself & secondary are invasion from adjacent 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:

Haussam Elenin is a UK qualified with an MD in Minimal Access Surgery at Dundee Univ 2005 and FRCS Glasgow 1999. My Work is permanent at Antrim Area Hospital(Queens' Univ Hospitals) since 2023 as Associate Specialist in Colorectal and Laparoscopic Surgery. My Specialist interest is in Laparoscopic Colorectal. I had over 600 laparoscopic appendectomies, 400 cholecystectomy as well colorectal resection. I have over 15 publications since 2012. Currently, I am Regional Surgical Advisor and Surgical Tutor for RCPS Glasgow.

Abstract:

Hand assisted laparoscopic surgery is an updated highly advanced version of laparoscopic technique. Such technique bridges the gap between traditional surgery and total laparoscopic surgery. Introduction of the hand intracorporeally enhanced the degree of freedom, hence, a remarkable degree of precision and safety in task performance.Clinical and experimental studies confirmed safe use of the hand with insufflation pressure enhancing dexterity as well as a steep learning curve. Therefore, the author made an overview analysis to the factors related to safety;efficiency; dexterity; instrumentation and cost-effectiveness for the use of hand assisted laparoscopic surgery; with an emphasis on live donor nephrectomy.Prospective studies made by Kolvenbach on the use of hand assisted laparoscopic surgery in aortic aneurysm repair proved high degree of safety and efficiency as well as cost effectiveness. Several studies highlighted a multitude of factors significantly contributing into a high degree of precision and task performance; which reflected on uneventful enhanced recovery programme.The introduction of either hand intracorporeally enhanced the limited degree of freedom for the current laparoscopic tools. There are various hand port devices of which the pros and cons for each port will be discussed in detail. The author’s experimental studies confirmed that optimum safe insufflation pressure would be 10 mm Hg with no leak from the hand port and optimum dexterity and task performance.Therefore, Hand assisted laparoscopic surgery is a safe and efficient technique. It significantly enhances concept of Enhanced Recovery programme. Raising public awareness can provide a high impact in enhancing live donor nephrectomy; hence reducing the inexorable renal transplant waiting list for patients with end stage renal disease. Such patients are at progressive rise of mortality risk with prolonged waiting list

Biography:

Ujwal gajula has his interest in clinical medicine and therapeutic gastroenterology. Hobbies being playing cricket.

Abstract:

Introduction: sarcopenia is one of the most common complications of cirrhosis which adversely affects survival, quality of life and overall outcome. Aim: To assess the prevalence of sarcopenia in patients with chronic liver disease and correlate sarcopenia with severity of liver disease. Methods: Computed tomography (CT) was performed to assess sarcopenia in all patients as per the protocol. Sarcopenia was compared with other modalities of nutritional assessment such as SGA and HGS in the study. Results: A total of the 95 patients included. The mean age of the study population was 50.82 (+/-9.5 SD) years. Gender specific Psoas muscle index cut-off values to define sarcopenia were derived from a pilot study of sixty healthy adults between the age group 20-30 yrs. These cut-off values were <5.67 cm²/m² in males and <3.57 cm²/ m² in females. Prevalence of sarcopenia from these cut-off values was sixty one percent (61%) in the study. On univariate analysis, bilirubin, albumin, INR, hemoglobin, MELD, CTP score were associated with sarcopenia. Complications of the chronic liver disease such as ascites, hepatic encephalopathy and jaundice and AKI were more commonly seen in patients with sarcopenia (P-value <0.005). Prevalence of malnutrition by subjective global assessment was 49.5% in the study. Prevalence of impaired hand grip strength estimated from the gender and age specific normal reference values was 63.2% (60/95). Conclusions: Prevalence of sarcopenia in chronic liver disease was 61% in the present study. Sarcopenia was correlated with the severity of chronic liver disease (assessed by CTP score and MELD score). Bilirubin, albumin, INR, hemoglobin were associated with sarcopenia in the study. Presence of complications of the liver disease such as ascites and hepatic encephalopathy, AKI were associated with sarcopenia. Nutritional assessment methods such as Subjective global assessment (SGA) and hand grip strength (HGS) were able to exclude / predict sarcopenia in majority of the CLD patients with CTP class A and C.SGA and HGS can be used as a screening tool to assess nutritional status in these patients. In patients with CTP class B, neither SGA nor HGS were able to predict sarcopenia accurately.

Biography:

As a consultant in surgical speciality in Sher-i-Kashmir Institute of Medical Sciences,  I deal with all surgical cases especially Colorectal cases, that involves investigating as well as treating these patients. I am especially interested in  lap colorectal surgery and TEMS/TAMIS besides all emergencyMainly interested in Lap LAR, Lap APR, Lap Rectopexy, Lap Adhesionolysis besides most of the abdominal lap proceduresTeacher of Colorectal Surgery for postgraduate training in IndiaTeacher for postgraduate Teaching in General Surgery in IndiaTeacher for undergraduate Teaching in General Surgery

Abstract:

BACKGROUND : Radical surgery for rectal tumours has high morbidity. Local excision of such tumours can be achieved without compromising oncologic safety. However tumours that are not accessible to traditional local excision can be approached using TAMIS.OBJECTIVE: The objective  of our study was to assess the feasibility of TAMIS procedure in terms of intra operative & postoperative complications, operating time, resection margin positivity, hospital stay and local recurrence rate.METHODS: A total of 24 patients with rectal tumours (benign or early rectal cancer) located within 4 to 15 cm, occupying <40% of circumference and size < 4cm, who were subjected to TAMIS, prospectively over a period of 2 years were included in the study.RESULTS : TAMIS was performed for 16 benign and 8 adenocarcinomas, which were located at an average distance of 6.2 (4-10) cm from anal verge. The mean operating time was 72 (46-110) minutes. There were no intraoperative complications, however 1 (8.33%) patient suffered post operative bleeding, which was managed conservatively.2 (8.33%) patients developed acute urinary retention who required indwelling catheterisation. Resection margin was positive in 3 (12.5%) cases (2 adenocarcinomas and 1 villous adenoma). Average hospital stay was 2.7 (2-9) days. Follow up period ranged from 2 to 28 months. Local recurrence occurred in 2 (8.33%) villous adenoma patients (after 11 and 13 months), in whom redo TAMIS was done.CONCLUSION: TAMIS is a safe and feasible procedure for benign tumours and early rectal cancers, located in low and middle rectum.

Biography:

Carlos Sanjuan is graduated from the Centro Medico Nacional La Raza in General Surgery and from Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran from Colorectal Surgery both in Mexico City and accredited by the Universidad Autonoma de Mexico. He also made a fellow in colorectal and pranceato-biliary surgery in Leuven, Belgium. He has focuses in inflammatory bowel disease.

Abstract:

The inflammatory bowel disease is one of the most complex entities to treat.  The correct identification of every relapse in proper time and the clinical deterioration of the hospitalized patient are the paramount of the clinical and the surgeon. It is well known that both professionals must work together but sometimes it is difficult, so the question is, when to call the surgeon. In this presentation we will see special situations to call the surgeon and how to make the relationship the best as possible in order to improve the evolution of our patients.

Biography:

Luis Fernando Sandoval graduated of general medicine from Universidad de San Carlos de Guatemala (San Carlos University of Guatemala), with a master degree, cum laude and chief of residents in Internal Medicine at IGSS. He works as Internal Medicine Attending Physician in the same institute, and as professor in Universidad Francisco Marroquin (Francisco Marroquin University). Locally he has published researches about gastric cancer, esophageal varices, cirrhosis and HCC.  He has showed the first epidemiological formal evidence of the non-cirrhotic HCC at IGSS and Guatemala. The recent data of HCC has opened the curiosity of international researches for seeking the etiology of these neoplastic lesions.         

Abstract:

Statement of the Problem: Guatemala has the highest incidence and mortality of hepatocarcinoma (HCC) in Latin America and the Caribbean (Cancer Today, 2012). HCC is associated with chronic liver disease and cirrhosis regardless of the etiology. Only about 10% of HCCs develop in non-cirrhotic livers. HCC can be diagnosed in cirrhotic patients non-invasively on the basis of radiologic findings (Tiffany Hennedige, 2012). Biopsy is only performed when there is a low probability of HCC (doesn´t have cirrhosis, chronic hepatitis B nor current or prior hepatitis C) (NCCN, 2018). IGSS previous data base have showed more than expected HCC in non-cirrhotic (71%), so we have to evaluate our diagnostic protocol with the use of functional three phase CT. Methodology & Theoretical Orientation: Observational, retrospective and analytic study.  All the liver masses seen by functional three phase CT were included and compared with the pathology result during 2015 – 2017 in IGSS. Statistical analysis was performed with PSPP 2007. Categorical variables were presented with frequency and percentages, and analyzed by chi squared of homogeneity. Normality was tested with Kolmogorov-Smirnov. Numerical data were evaluated with t-student of independent samples. At relational level a bivariate study was made, then elevated to multivariate level. NPV and PPV was calculated. Findings: Total of 76 liver masses evaluated by functional three phase CT were analyzed, with 53.85% of HCC confirmed by biopsy; 84% of HCC diagnosis were non-cirrhotic livers. Taking all the samples, our functional CT has a PPV of 0.54 and NPV of 0.69 for HCC diagnosis. After stratification, in cirrhotic samples a PPV of 0.25 and NPV of 0.83, vs. non-cirrhotic a PPV of 0.67 and NPV of 0.62 were obtained. These findings are opposite to the global epidemiology, our main HCC source are the non-cirrhotic livers, and that´s why we have different experiences in functional imaging.             

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INTRODUCTION AND OBJECTIVES: Familial adenomatous polyposis (FAP) is an inherited disease transmitted as an autosomal dominant genetic defect in the long arm of chromosome 5 (5q 21), and manifests with multiple adenomatous polyps in the large intestine ( over 100). carcinomatous degeneration is inevitable and natural evolution of the disease. The first case was published in 1881 by Sklifasouski. The incidence is 1 in 10000.El conventional surgical treatment of ulcerative colitis refractory to medical treatment and familial adenomatous polyposis was the total proctocolectomy and definitive ileostomy according Brooke. Los rectal sparing procedures, required reoperation to remove the rectum remnant, and finally making ileostomy terminal. Restorative Proctocolectomy, introduced by Park in 1978, represented a breakthrough for the treatment of these patients, mostly young people, because, apart from making a complete ablation of the disease, ileostomy is avoided, providing a better quality of life for patients.MATERIAL AND METHODS: In the period from January 1986 and February 2014, 124 cases were operated, 104 of ulcerative colitis (UC), and 20 cases of familial adenomatous polyposis (FAP), Restorative Proctocolectomy with “J” ileal Pouch anal-anastomosis .RESULTS: In ulcerative colitis the 104 cases, 54 were conducted in two stages, and 50 in three stages. Of the 20 patients with familial adenomatous polyposis, 17 in two stages, and 3 cases in one stage. In all cases we performed J Ileal Pouch of 15 to 20 cm long, in all but 6 cases with mechanical sutures and manual suture in only  6 cases. : Postoperative complications occurred in 30 cases, include: fistula at pouch-anal anastomosis: tow cases, pelvic sepsis: two cases, intestinal subocclusion: 8 cases.Haemorrages of pouch that required reoperation: two cases, fistula at ileostomy closure two cases, severe pouchitis (requiring hospitalization): 3 cases, moderate pouchitis: seven cases, maissive pulmonary postoperative embolism in one case.Mortality: nul. Functional outcomes: defecation / 24 hr.: Media 4.8, normal continence: 1108 daytime, night 98, ability to defer defecation> 30 min. 106 cases. Satisfactory sexual-social life 101. Elimination of the pouch: one case. Exclusion pouch: one case.CONCLUSIONS: Restorative Proctocolectomy remains the best method for surgical treatment of familial adenomatous polyposis and ulcerative colitis. Most postoperative complications were mild or moderate in nature, being the experience of the surgeon factor of great importance in this regard. Surgical mortality in our series was nul. Functional results are satisfactory, with a good quality of life . We recommend lateral temporal ileostomy (two or three stages times operation), in cases of severe ulcerative colitis, and in patients who have received high-dose corticosteroids and / or Ciclosporina. The incidence of pouchitis in our series is not very high, and usually controlled with medical treatment.

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Introduction:This literature provides a review regarding the value of checking ammonia level in hepatic Encephalopathy. The research examines the prognosis of Ammonia level in the blood, diagnosis and management of hepatic encephalopathy.Diagnosis of Hepatic Encephalopathy:The major clinical characteristics of diagnosis of hepatic Encephalopathy are depressed consciousness level, intellectual impairment and personality changes. During diagnosis, it is essential to detect signs suggesting hepatic encephalopathy among the patients suffering from liver disease and there is no clear indication of other causes to brain dysfunction. Thus, realization of precipitating factors indicated above supports hepatic encephalopathy diagnosis. The prognosis depends on the grade of liver failure, time of delivering effective treatment particularly precipitating factors and comorbidity. The progress of hepatic encephalopathy among patients with cirrhosis is correlated with a worse prediction and might cause frequent and elevated relapses. The patients with obvious hepatic encephalopathy in the hospitals have a 3.9 risk of increased mortality. Approximately 70% of having cirrhosis exhibit restrained symptoms of hepatic encephalopathy ⁽⁸⁾. These symptoms are likely to weaken patients.  Obvious hepatic encephalopathy manifests in patients suffering from cirrhosis, and the approximate infection rate is 30 to 45%. About 25 to 53% port systemic shunt surgery patients exhibit the condition.Management of Hepatic EncephalopathyThe suitable management practices entail early diagnoses, aggressive identification of the precipitating factors and efforts to reduce severity ⁽⁵⁾. Evasion of some sedative drugs has been proposed as a key management practice. The main approaches suggested in include: checking the level of arterial ammonia during first evaluations in patients hospitalized due to impaired mental function and or cirrhosis. In stable outpatients, ammonia levels are low. Correcting hepatic encephalopathy precipitants, including constipation, gastrointestinal bleeding, metabolic disturbances and hypovolemia. Providing prophylactic endotracheal intubation to patients with grade 3 or grade 4 (severe encephalopathy), and have aspiration risks in the intensive care unit (ICU). Lactulose and rifaximin use is useful but no superiority and can both be used if needed.Administration of low-protein diets in cirrhosis patients resulted in deteriorating of established protein-energy malnutrition. Thus, protein restriction is likely to help some patients with immediate effect after episodic hepatic encephalopathy. Certainly, malnutrition is regarded as a serious clinical problem compared to hepatic encephalopathy among the patients ⁽¹²⁾.Conclusion:Bloods ammonia mainly comes about due to the breakdown of the unabsorbed dietary protein by bacteria in the intestines. Among the hepatic encephalopathy, the levels of ammonia in the brain are higher compared to blood levels. High levels of ammonia in the blood may occur because of gastrointestinal bleeding, acute liver failure and chronic liver disease. The major reasons for testing ammonia levels in hepatic encephalopathy for patient who is presenting for the first time include: checking for success of treatment options, checking for liver condition following severe symptoms like excessive sleepiness and confusion, identifying disorders likely to cause brain damage, help in predicting outcomes from diagnoses carried out prognosis of hepatic encephalopathy, however, for patients who are known to have hepatic encephalopathy, in terms of recurrent admissions or previous diagnosis, checking ammonia is not routinely recommonded and carrying out the psychometric tests may be more useful.

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Background Classic esophagojejunostomy using a circular stapler is the most commonly performed standard reconstruction procedure in open surgery, then this technique should be the preferred method of esophagojejunostomy in laparoscopic surgery. In circular stapling method, the most difficult steps are placing the purse-string suture and anvil which limit its widespread applications. To address this problem, we introduced a novel self-pulling and holding technique to place the purse-string suture for intracorporeal circular-stapled esophagojejunostomy in laparoscopic surgery.  Methods Creation of the purse-string suture was performed by hand with assistance of constant self-pulling and holding of the uncut right esophagus on the transected esophageal end after subtotal circumferential transection (90%) of the distal esophagus. A needle insertion from the serosal side or the mucosal side of the esophageal lumen was chosen to avoid placing a backhand stitch in addition to the easy needle insertion from the mucosal side on the posterior esophageal wall. 5- years follow-up for the patients underwent the procedure was completed. Results Between June 2009 and December 2012, 52 patients with gastric cancer underwent consecutive laparoscopic total gastrectomy using the procedure for intracorporeal circular-stapled esophagojejunostomy. The mean (±SD) operating time was 297.1±53.0 minutes, and the time of the purse-string suture and anvil placement was 18.3±6.1 minutes. There were 3 major postoperative complications: one for anastomotic bleeding, two for ileus. During 5- years follow-up periods, there were no instances of postoperative anastomosis-related complications observed except for one with stenosis, Conclusions We believe that this method is feasible and reliable to create the purse-string suture for intracorporeal circular-stapled esophagojejunostomy by a long-term follow-up.

Biography:

April Posadas Calleja finished her Bachelor of  Science in Biology at the University of the Philippines Baguio. She finished Doctor of Medicine at Far Eastern University Dr. Nicanor Reyes Medical Foundation. She is currently on her second year residency training program in Internal Medicine at World Citi Medical Center. She believes that equality for all means healthcare for all.

Abstract:

Background: Dieulafoy’s lesion is a rare cause of gastrointestinal hemorrhage. The most common location is the stomach along the lesser curvature but it may also be seen in extra gastric locations specifically the duodenum. We reported an isolated case of Dieulafoy’s lesion of the second portion of the duodenum at a private institution in the Philippines and discuss the endoscopic diagnosis and management of this uncommon lesion.Case Presentation: An isolated case of upper gastrointestinal bleeding in a 34-year-old male known hypertensive with gouty arthritis who was on chronic nonsteroidal anti-inflammatory drugs (NSAID) use, later reported to be a case of Dieulafoy’s lesion. Endoscopic diagnosis was performed and treatment was done by endoscopic sclerotherapy using epinephrine.Conclusion: Dieulafoy’s lesion is a rare etiology of gastrointestinal bleeding but may even be complicated by an unusual location such as those seen in the duodenum hence spreading awareness about this intricate lesion by including it in our differentials, may help improve early detection and treatment.