Date - Nov. 6Nov. 7, 2021
Venue - China Medical University
|Conference Hall||Classroom 101||Classroom 102||Classroom B201||Classroom B202||Classroom B203|
Endoscopic pancreaticobiliary drainage
Colorectal Cancer Screening: Optimize colonoscopy quality
How to perform a qualified motility procedure
Advanced pancreatobiliary procedure
Rethinking non-polypoid colorectal lesion
Small bowel tumor
Big debates on colonoscopy practice
Big debates EUS
Endoscopy in inflammatory bowel disease (IBD)
Big debates stomach
|Conference Hall||Classroom 101||Classroom 102||Classroom B201||Classroom B202||Classroom B203|
Chairman speechProf. Chun-Che Lin
Gut Microbiome and Colon Diseases
China Medical University Hospital
In the last decade numerous works have established a clear relationship between alterations in the gut microbiota composition and diverse human pathologies. In particular, obesity and associated metabolic disorders, autoimmune diseases, and several types of colon diseases, esp. colon cancer, are characterized by changes in the microbiome and gut dysbiosis.
The gut microbiota produces a diverse metabolite repertoire that may harm or benefit the host. Alterations in the intestinal bacteria balance could lead to changes in the levels of gut microbial metabolites such as short-chain fatty acids (SCFAs), polyphenols, vitamins, tryptophan catabolites and polyamines, which could be related to the pathogenesis of the human diseases described above.
Recently, several studies have demonstrated that gut microbiota can alter colon diseases susceptibility and progression by modulating mechanisms such as inflammation and DNA damage, and by producing metabolites involved in diseases(tumor) progression or suppression. Dysbiosis of gut microbiota has been observed in patients with CRC, with a decrease in commensal bacterial species (butyrate-producing bacteria) and an enrichment of detrimental bacterial populations (pro-inflammatory opportunistic pathogens). Therefore, a personalized modulation of the pattern of gut microbiome by dietary or non-dietary may be a promising approach to prevent the development and progression of colon diseases and to improve the efficacy of therapy.
Keynote lecture(Ⅰ)Prof. Haruhiro Inoue
Novel endoscopic Dx and Tx for persistent GERD
Haruhiro INOUE, MD. PhD, FJGES, FASGE
Digestive Diseases Center, Showa University Koto Toyosu Hospital, Tokyo, Japan
Acid suppressive medicine is the first-line treatment for GERD. For refractory GERD surgical fundoplication has been recommended in long term. Surgical fundoplication is the only treatment procedure to control refractory GERD with sliding hernia.
ARMA (anti-reflux mucosal ablation) is a novel minimally invasive endoscopic treatment for refractory GERD with no sliding hernia. Some GERD patients just have open hiatus without sliding hernia. Those cases can be treated by this simple flexible endoscopic procedure. Semi-circumferential mucosal ablation at gastric cardia is conducted to induce artificial ulceration. Mucosal flap valve at junction is rebuilt and reinforced in its healing process.
If esophageal motility is extremely low such as achalasia, Dor (anterior patrial fundoplication) is selected in laparoscopic surgery. Now we can complete this procedure using flexible transoral endoscope. POEF (Per-oral endoscopic fundoplication) is a pure NOTES procedure which creates anterior partial fundoplication.
In diagnosis LES function is a crucial factor of GERD mechanism. Now LES function can be evaluated by EPSIS (endoscopic pressure study integrated system).
In this lecture these novel procedures are presented and discussed.
Keynote lecture(IV)Prof. Peter V Draganov
Keynote lecture(Ⅱ)Prof. Shinji Tanaka
Magnifying colonoscopy in colorectal tumor – present status and future perspective
Shinji Tanaka，MD, PhD
Hiroshima University, Hiroshima, Japan
In addition to pit pattern diagnosis by magnifying colonoscopy with chromoagents, recently the progress of endoscopic technology has provided an image-enhancement endoscopy (IEE) magnification in clinical field. The Japan NBI Expert Team (JNET) classification, which is based on NICE classification, was proposed as a first unified narrow-band imaging (NBI) magnifying endoscopic classification for colorectal tumors in Japan. It has been widely used in Japan, and also graduately spreading to other countries. IEE magnification doesn’t need chromoagents. Although for NICE classification magnification is not essential, for JNET classification magnification is essential.
In this lecture, I will talk about the JENT classification in detail with the knack and pitfall to use it with case presentation, including further qualitative diagnosis by applying JNET classification. Also, I also want to mention AI/CADx about JNET classification and consider future perspective of magnifying colonoscopy in colorectal tumor.
Reference: Sumimoto K, Tanaka S, et al. Gastrointest Endosc 2017; 85: 816-21, Sumimoto K, Tanaka S, et al. Gastrointest Endosc 2017; 86: 700-9 and Okamoto Y, Tanaka S, et al. J Gastroenterol Hepatol. 2021 Sep 3. doi: 10.1111/jgh.15682.
Keynote lecture(V)Prof. Mitsuhiro Kida
Recent Advancement of Endoscopy
Department of Gastroenterology, Kitasato University
Recent epochal development of endoscopy are endoscopic ultrasonography (EUS), balloon endoscopy, and electrical image enhancement.
Now therapeutic EUS such as EUS-guided PFC/WON drainage, EUS-biliary drainage (EUS-BD, HGS and CDS), EUS-pancreatic duct drainage (EUS-PD), and EUS-gastrojejunostomy (EUS-GJ) etc. have been employed in the clinical fields.
Endoscopic diagnosis / treatment for surgically altered patients were not feasible practically before 2000. After introduction of balloon endoscopy (BE), these diagnosis / treatments have been possible year by year. In general, the rate of reaching blind end is around 90% with BE. Stenosis of anastomosis are treated by balloon dilation, plastic stent, and metallic stent.
Nowadays, special designed metallic stent has been developed for treating anastomotic stenosis. Hepatolithiasis and bile duct stone in surgically altered anatomy patients are also treated by EPLBD, balloon dilation, and EHL under direct cholangioscopy. However, remaining 10% could not be treated by BE. In this situation, collaborated with EUS-FNA techniques are essential to solve the problems. EUS-HGS will be useful in the treatment of not reaching blind end case such as biliary drainage and antegrade bile duct stone removal, etc. In case of complete anastomotic stenosis, direct puncture could create EUS-hepatojejunostomy and EUS-pancreaticjejunostomy with forward-viewing echo endoscope.
Recently new processor, X-1, has been developed. It has become possible to detect faint lesions with TXI (texture enhancement imaging). It has also become possible to identify bleeding point in case of UGI bleeding or during ESD with RDI (red dichromatic imaging).
Anyway I will share our experience with you in DEST.
Keynote lecture(Ⅲ)Prof. Yutaka Saito
Change the future! Innovative system creates a new future.
Yutaka Saito, MD, PhD, FASGE, FACG, FJGES
Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
The gastroscope was developed in the 1950s, followed by the Fiberscope, and the videoscope in the 1980s. In the 2000s, high-definition image quality was introduced. In addition to conventional dye chromoscopy, image-enhanced endoscopes (IEE) such as Narrow Band Imaging and Blue laser Imaging have been developed and are routinely used in daily practice. These IEEs have greatly contributed to the early detection of early-stage cancers, and have led to a significant shift in treatment strategy from surgery to endoscopic treatment.
In addition, innovative endoscopic treatment methods have been developed over the past 15 years since polypectomy in 1968, from the EMR era in the 1980s to ESD in the late 1990s. It was a breakthrough because it eliminated the limitation of tumor size for endoscopic treatment.
The fact that the number of cases of ESD now exceeds those of surgical procedures in the treatment of early-stage gastric cancer is proof of the clinical significance of ESD.I am convinced that in the next 20 years, endoscopic practice will move into the era of AI and molecular imaging in diagnosis, and that submucosal endoscopy and full-thickness resection will be more actively used in treatment beyond ESD.
Keynote lecture(VI)Prof. Ichiro Yasuda
A new stage of endoscopic diagnosis of pancreatobiliary diseases
Third Department of Internal Medicine, University of Toyama
Endoscopic procedures for diagnosis of pancreatobiliary diseases are divided into two categories, namely EUS-related and ERCP-related procedures. EUS has become an essential diagnostic tool for pancreatobiliary diseases. In addition to the fundamental B-mode imaging, the tissue harmonic imaging made the image clearer. The color or power Doppler imaging allowed the detection of vessels and the evaluation of vascularity in the lesions. The contrast-enhanced harmonic EUS (CE-EUS) with intravenous contrast injection enabled more minute evaluation of the vascularity.
Furthermore, recent advances in microflow imaging may improve the ability to detect microflow in small vessels without using contrast agents. EUS-elastography can evaluate the tissue hardness. In addition to the strain elastography depicting the tissue hardness by color scale, recent development of the shear-wave elastography may enable the quantitative measurement of tissue hardness. Recent development of various EUS-guided biopsy (FNB) needles enabled to obtain core biopsy samples easier. It may facilitate gene analysis of the tumor for the precision medicine. Peroral cholangioscopy and pancreatoscopy (POCS/POPS) enabled the direct visualization of the bile and pancreatic ducts. The novel scopes improved the image quality and maneuverability. It also equipped additional image enhancing functions. I will review such recent development on endoscopic diagnosis of pancreatobiliary diseases.