December 14, 2016: This morning, Sheikh Hamdan Bin Rashid Al Maktoum Award for Medical Sciences held 12 workshops on Gastroenterology, with a focus on the liver, pancreas and colon diseases. This came within the activities of the 9th Dubai International Conference for Medical Sciences, which is organized by the award over three consecutive days at the JW Marriott Marquis Hotel, Dubai, in conjunction with the award ceremony for honouring the winners of its 9th term.

 

In this context, Prof. Jeremey Wilson, from Liverpool Hospital, University of New South Wales, Australia, discussed the Pancreatic stellate cells in health and disease. 

 

In healthy pancreas, the cells maintain homeostasis of the pancreatic extracellular matrix, has the capacity to act as immune cells and have a role in pancreatic exocrine secretion (enzymes & bicarbonate).

 

It has a role in the repair processes of the gland after acute pancreatitis. While in chronic pancreatitis, these cells have a role in the accompanied fibrosis. In pancreatic cancer they interact with cancer cells to facilitate tumour progression. 

 

The improved understanding of PSC functions, has led to the development of novel therapeutic approaches that have often been effective in the pre-clinical setting and needs to be implemented in the clinical setting.

 

Prof. Eamonn Quigley, from Underwood Center for Digestive Disorders at Houston Methodist Hospital, Texas, USA, presented a workshop entitled Chronic Constipation – a common, potentially disabling but under-researched issue.

 

The recent definitions of chronic constipation have moved from the former emphasis on stool frequency alone to encompass other symptoms as distension, straining.. ect. Many factors contribute in the development of the case such as colonic motility, pelvic floor musculature, anal sphincters. Tests may be applied to assess the relative contributions of these factors.

 

Accordingly, new therapies attempt to not only increase frequency of defecation but also to address such symptoms.

 

laxatives are considered the traditional remedies for constipation, other therapies like the pro-kinetic agent, and the pro-secretory agents , have shown efficacy  Other novel approaches, such as the inhibition of ileal bile salt absorption, offer particular promise.

 

Prof. Olivier Goulet, from Paris Cite-Sorbonne, Paris Decartes Medical School, France, presented a workshop entitled Chronic Intestinal Pseudo-Obstruction Syndrome.

 

Chronic intestinal pseudo-obstruction syndrome (CIPOS) is a cause of neonatal or post-natal progressive intestinal failure. CIPOS is often unrecognized, and the diagnosis delayed by several years with useless and potentially dangerous surgeries. 

 

In the pediatric age group, most cases are idiopathic and sporadic, even though, forms with either dominant or recessive autosomal inheritance have been described.  CIPOS can occur in patients with underlying diseases associated with gastrointestinal manifestations (ex: hypothyroidism,.) and viral and parasitic causes

 

CIPOS always involves alterations of smooth muscle contractile function, leading to abnormal intestinal tract peristalsis and nutritional disorders. Treatment of CIPOS involves nutritional, pharmacological, and surgical therapies, but is often does not change the natural course in the majority of cases. The nutritional management has a crucial importance in pediatric age 

 

Surgery is one of the main stays of CIPOS therapeutic management as it is performed in a variety of situations in pediatric patients but surgical options must be evaluated carefully.

 

Prof. Jean Francois Rey, President Elect of the World Endoscopy organization, and Practicing physician at Institute Arnault Tzanck, France, presented a workshop about the Colon capsule endoscopy, which is an emerging form of colon imaging that may be useful to improve compliance with colorectal cancer screening. 

 

The device still has its limitations for example it is currently only diagnostic, any positive findings require conventional colonoscopy for tissue sampling or Polypectomy. 

 

In addition, the time required to read a capsule endoscopy is likely longer than that required to perform a traditional endoscopic examination.

 

For these reasons, a second-generation colon in particular, the frame rate has been increased from 4 to 35 images per second from the first to the second generation. The angle of view from each of the two capsule ends also has been increased from 156° to 172° for each lens, in order to nearly cover 360° of the colon surface. 

 

 

Contemporary Management of Chronic Pancreatitis, is a title of a workshop presented by Professor Kevin C. Conlon, from Trinity College Dublin, and Academic Head of the Department of Surgery Tallaght Hospital, Ireland, 

 

Chronic pancreatitis is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in exocrine and endocrine insufficiency. Typical clinical symptoms are vague therefore Diagnostic tests are required but none provide absolute diagnostic results, especially in the early stages of disease. This workshop will address the contemporary issues regarding epidemiology, diagnosis, and surgical therapies in the management of this condition.

 

 

Prof. Richard Thompson, Professor of Molecular Hepatology, and Consultant Paediatric Hepatologist, King’s College Hospital, London, spoke about Diagnosis and management of cholestatic liver disease.

 

A whole array of tools has been used in the diagnosis of cholestatic liver disease. Simple biochemical and complicated biochemical testing, particularly looking for intermediate metabolites has greatly improved our knowledge in recent years. Liver biopsy has been a key part of the diagnostic repertoire for many years. Next Generation Sequencing technology has completely transformed the way we can use genetics. They can now be used much earlier in the diagnostic pathway, and in that way avoid lots of other testing. 

 

ERCP in Patients with Surgically Altered Anatomy, is the title of a workshop presented by Prof. Firas Al-Kawas, from Sibley Memorial Hospital, USA.

 

ERCP plays an important role in the evaluation and management of patients with a variety of pancreato- biliary disorders. In expert hands, ERCP success rates exceed 95% in patients with normal gastrointestinal anatomy. 

 

Surgical alteration in upper GI anatomy can present a variety of challenges to the endoscopist when performing ERCP especially if these operations significantly change the anatomy. Success rates using this approach are overall lower than standard ERCP. In such patients, options include gastrostomy, laparoscopy and EUS ( endoscopic us) assisted ERCP allowing entry into the isolated stomach and completing procedure as a standard ERCP  . Increasing experience and improved availability of accessories will likely increase success rate in this population in the future.

 

Dr. Dalia Belsha, from Leeds Teaching Hospital, UK, spoke about Acute Upper Gastrointestinal Bleeding in Children. 

 

Lack of recognition of severity of acute gastrointestinal bleeding in children and the lack of a reasonable skill base to treat it endoscopically are common problems in pediatrics. It is common practice for pediatric gastroenterologists to collaborate with adult gastroenterologists and pediatric surgeons in the case of a serious gastrointestinal bleed. 

 

Variceal bleeding is the use of variceal band ligation or sclerotherapy (injection therapy) Non variceal bleeding can be controlled using mechanical method (for example, clips) or thermal coagulation with adrenaline.

 

The choice of method depends on the situation as well as the endoscopist's experience and level of confidence with a particular method. 

 

 

Prof.  Ronan O’Connell, University College Dublin, School of Medicine and 

Medical Sciences, Ireland, talked about Investigation and Management of Faecal 

Incontinence.

 

The majority of patients presenting with faecal incontinence (FI) can be managed conservatively with dietary advice, physiotherapy. Surgical interference is for patients who have failed conservative therapy or have severe anatomic or neurological dysfunction.

The integrity of the anal sphincter complex should be assessed by endoanal ultrasound. Ancillary tests include anal manometry, electromyography, and others.

 

The presence of an anatomic anal sphincter defect will lead to the surgical approach, such as reconstruction, artificial anal sphincter implantation. If no or minimal defect, sacral nerve stimulation (SNS) and biomaterial injection therapy are used.  

 

Patients who fail surgical therapy for FI, or who do not wish to undergo extensive reconstruction, should consider placement of an end sigmoid colostomy. Novel therapies as the magnetic anal sphincter.

 

In the workshop presented by Dr. Arun Urs, from Center for Paediatric Gastroenterology, Sheffield Hospital, UK, he dealt with Paediatric Endotherapy.

 

The evolution of the equipment and technological innovations of the last decade in gastrointestinal endoscopy has become a key element in the diagnostic and therapeutic procedures.

 

The emphasis in children’s endoscopy is different to adults as one of the particular problems in children is the management of foreign bodies with urgent care or cautious observation. Although the GI bleeding is rare but oesophageal strictures are more common and are generally benign and can be due to wide range of anatomical and functional disorders. Endoscopic therapies include injection, thermal coagulation, band ligation, and mechanical clipping.