EDW Salvador - DDW 2009

OMED will present an interactive Endoscopy Directors´ Workshop in Salvador (Brazil) on Monday, October 26, 2009 as part of the XXXV Congresso Brasileiro de Endoscopia Digestiva. EDWs provide participants with the knowledge required to organize their endoscopy service, to develop their own protocols, quality assurance and training. Please click here to learn more.

» Please click here to learn more

Every research paper that was presented at DDW 2009 is summarized on the OMED website through the courtesy of Dr. Jonathan Cohen, Dr. Gina Sam and GI Fellow volunteers.  The OMED website has also archived all the previous summaries of oral research presentations at the past several DDWs, UEGW meetings (via Professor Spicak in Prague) and those given at APSDE (collected by Professor A. Chan). Even if research is not your interest, these summaries hold considerable information on new thoughts, new procedures and future developments in the field of endoscopy, covering contributions from every part of the entire world.

» Please click here to learn more

 Upper GI Cancer Screening Committee Report

Within the standing and ad-hoc committees OMED comprises, special project needs are identified and depending on the type of committee, reports and consensus statements are presented and research is promoted.

The Upper GI Cancer Screening Committee has compiled a report on alternative tests for screening for gastrointestinal cancers in collaboration with the Colorectal Cancer Screening Committee under the leadership of G. Young. The goal of this guidelines process has been to reach consensus on how best to compare the “new” with proven screening tests, on the ideal context and/or process for comparative research, on the informative endpoints and on the appropriate study design. A systematic review of literature addressing strategies for comparing diagnostic and screening tests was undertaken together with a consensus approach involving experts who agreed on key questions, their respective answers and the final recommendations.

Based on this report, a Working Party will be reporting the Consensus on Cancer Screening Tests at the Gastro 2009 London.

» Read more

 The First International Symposium on Sedation in Digestive Endoscopy

The First International Symposium on Sedation in Digestive Endoscopy was held on September 18-19 in Athens Greece. Under the joint sponsorship of the World organization for Digestive Endoscopy and the European Society for Digestive Endoscopy and in collaboration with the Hellenistic Society of Gastroenterology, the symposium was designed to explore the viewpoints and practice of procedural sedation in Europe, North America, Asia and Africa.  A distinguished international faculty was assembled under the guidance of Anthony Axon, M.D. the president of OMED, Spiros Ladas, M.D. from the University of Athens who served as the symposium president, as well as David Bjorkman, M.D. and Lawrence Cohen M.D. from the United States.

Topics included the preprocedural assessment, pharmacology of sedation agents, intraprocedural assessment and monitoring, identification and management of complications, training, and the use of propofol by gastroenterologists. A unique aspect of the symposium was the formulation of thirty evidence-based statements by the faculty which were voted upon by the attendees of the symposium.  A position statement based on the evidence based statements and under the direction of Dr. Cohen will be published.

It is hoped that the international consensus that is garnered from the statement will serve as a resource for the development of a universal approach to procedural sedation for gastrointestinal endoscopy.

For those who missed the Athens meeting, GASTRO 2009 will give opportunity to learn more about the achievements of the Sedation Symposium. A Common Interest Group Meeting will take place on Monday, November 23, 2009 and an outstanding faculty will lecture on the outcome of this exciting meeting.

Click here to view the endoscopy program including announcements of all OMED activities during GASTRO 2009:

» OMED activities during GASTRO 2009

 OMED Showcase: Centers of Excellence

This month OMED highlights the Digestive Diseases Center at Soon Chun Hyang University Hospital, Korea.

The Digestive Diseases Center at Soon Chun Hyang University Hospital was built in 1974 and organized as a University Hospital in 1980. The hospital has 800 beds with 11 operating rooms, it employs 350 doctors and 470 nurses. Of the 350 doctors, 100 are specialists with 60% of them having studied abroad in the United States, Canada, Japan and the United Kingdom. The physicians, nurses and trained professionals represent the qualities and standards associated with any leading medical facility. In a typical year, their physicians submit over 400 research papers for publication and a minimum of 100 presentations are made at numerous medical conferences and research institutions.

Esophageal stent insertion

Dr. Shim, from the OMED Center of Excellence in Korea, presents the technique for esophageal stent placement.  The patient had a previous stent placed through an esophageal cancer but after chemotherapy, the stent migrated.  Because of persistent dysphagia, Dr. Shim is placing another stent across the tumor.  The upper and lower margins of the cancer are marked with lipiodol injections so that the full extent of the tumor is visible fluoroscopically.  These radiographically visible sites will ensure proper stent placement.  Fluoroscopic control is an important adjunct for this procedure since the stent must be accurately localized before it is released.  Dr. Shim demonstrates the technique for deployment of an esophageal stent and discusses, with Dr. Hawes from the United States, the problems of stent migration and how this can be prevented.

» View live demonstration video

 NYSGE: Approach to Biliary Strictures

By Douglas A. Howell MD

The New York Society for Gastrointestinal Endoscopy is the largest regional GI endoscopy society in the United States. The Society is dedicated to the teaching and advancement of gastrointestinal endoscopy. The society runs numerous programs throughout the year, including an annual fellow’s endoscopy course each summer, and a major postgraduate endoscopy conference each fall. The next course will be held in New York from December 16-19, 2009.

Each month a syllabus entry from the 32nd Annual New York Society for Gastrointestinal Endoscopy Course can be accessed here. This month the entry is entitled ‘Approach to Biliary Strictures’ by Douglas A. Howell, MD.

Biliary strictures represent a challenge and opportunity for endoscopists both diagnostically and therapeutically.

When confronting a biliary stricture, both benign and malignant etiologies must be carefully considered.

Benign causes include:

• Primary sclerosing cholangitis
• Post-operative
• Traumatic
• Cystic duct stone impaction (Mirizzi) syndrome
• Compression from adjacent inflammatory disease (i.e., pancreatitis)
• Autoimmune pancreatitis

Malignant etiologies include:

• Pancreatic carcinoma
• Primary cholangiocarcinoma
• Gallbladder cancer
• Metastatic disease

At initial evaluation multiple questions must be answered before an approach to a diagnosis and treatment can be advanced.

» Read more

 Brainteaser/image of the month

by Bjorn Rembacken

This was found in a 60 year old lady presenting with anaemia. She has severe rheumatoid arthritis treated with naproxen, sulphasalazine and methotrexate. She is also hypertensive and takes a beta blocker together with nitroglycerin spray and low dose aspirin. A rapid urea test for H.pylori is negative at the time of her examination and biopsies from the edge of the ulcer does not reveal any evidence of malignancy. The patient is very reluctant to stop her NSAID.

What single treatment option is most likely to benefit the patient?

a) start misoprostol

b) start an H2 antagonist

c) change to a selective Cox-2 inhibitor

d) start a proton pump inhibitors

e) start sucralfate

» Click Here for the Answer and Explanation

 Additional Links

» OMED Events Calendar

» Resources