Abdominal Imaging and Endoscopy

Biography:

Yusuf Gunay, MD. He graduated from Ankara University medical school in 1999 and then completed a general surgery residency at Ankara Numune Hospital, Ankara, Turkey. He then completed  his first abdominal transplant surgery fellowship at The Ohio State University in 2010 and followed by MIS fellowship at University of Iowa in 2011 and  the second Abdominal Transplant surgery fellowship at University of Pittsburgh Medical Center in June 2017. Currently, he is an assistant professor at Bulent Ecevit University, Zonguldak, Turkey. He has many publications mainly in abdominal transplant surgery.

Abstract:

Chronic gastrointestinal blood loss is the leading cause of iron deficiency anemia in adult patients. Although abdominal computed tomographic (ACT) scanning is more accurate than endoscopy in the evaluation of mural and extraintestinal abnormalities of the gastrointestinal system (GIS), its usefulness in the evaluation of iron deficiency anemia is debated. The aim of our study was to investigate the concordance between endoscopy and ACT scan in the evaluation of asymptomatic adult patients with iron deficiency anemia.

Material and Methods

Laboratory studies included complete blood count, and total iron-binding capacity. Patients underwent endoscopy (colonoscopy, esophagogastroduodenoscopy), and ACT.

Result

Eighty four patients (38 men and 46 women) with the mean of age 60.7 (range: 19-83) years met the inclusion criteria of asymptomatic iron deficiency anemia. The mean hemoglobin level was 9.8±1.7g/dL. The concordance between ACT and endoscopy was found in 33 (39.3%) patients. The most common lesions identifed in CT and then confirmed with endoscopy were GIS wall tickness or tumor, diverticule and hiatal hernia. ACT detected some superficial mucosal lesions as stomach or colon wall thickness which were confirmed with endoscopy such as chronic gastritis and duodenitis, large colonic polyps and small malignant tumor.

Conclusion

This study suggests that ATC may be useful in patients with iron deficiency anemia without gastrointestinal symptoms.ACT has a good concordance with endoscopy for the detection of gastrointestinal lesions, and has the advantage in locating lesions prior to endoscopy.

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 Stomach & Duodenum can reveal following diseases. Gastritis & Duodenitis. Acid Gastritis. 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. Duodenal outlet obstruction due to Annular Pancreas. Gastro-Duodenal Ascariasis. Pancreatic or Biliary Stents. Foreign Body. Necrotizing Gastro-Duodenitis. Tuberculosis. Lesions of Ampulla of Vater like prolapsed, benign & infiltrating mass lesions. 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. Enlarged lymphnodes around may be seen. Primary arising from wall itself & secondary are invasion from peri-Ampullary 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:

Abstract:

Statement of the Problem: In 2009, the National Patient Safety Agency (NPSA) introduced the term “Never Events” into National Health Service practice (Moppett and Moppett, 2016). Never events are defined as a significant, fundamentally preventable patient safety incidents that could have been avoided if the healthcare provider had implemented suitable preventative measures (NPSA, 2009). Within the authors clinical area a never event occurred, following the insertion of the incorrect biliary stent.

This never event led to an evaluation of the existing nursing endoscopy documentation, which was noted to be unsatisfactory.

Methodology & Theoretical Orientation: Current literature regarding the incorporation of patient safety into endoscopy documentation was evaluated. Stakeholders with an interest in developing a new nursing care plan were approached and a new document was developed and completed within ten weeks. This new care plan contains Local Safety Standards for Invasive Procedures (LocSSIP’s) (NHS England, 2015; Tingle, 2016). An important element of the LocSSIP’s are the individual safety pauses which occur pre-procedure, during the procedure if any variances occur and finally, post-procedure, these replaced the currently used WHO checklist.  Prior to implementation of the nursing care plan into clinical practice the document underwent several PDSA cycles whilst being trialed by a group of endoscopy nurses caring for a small cohort of patients. Further training has been provided on the LocSSIP component of the document to enhance staffs understanding of this important patient safety improvement.

Conclusion & Significance: By implementing the new endoscopy nursing care plan with integrated LocSSIP and safety pauses an improvement in patient safety has been observed. Endoscopy staff have embraced the new documentation and no further never events have occurred since this document has been introduced.

Biography:

Currently He is working as associate professor of surgery in the Department of Transplantation, Hepatobiliary & Pancreatic surgery. National Liver Institute, University of Minoufiya, Shibin El-Kom, Minoufiya, Egypt and Consultant, general surgery, hepatobiliary surgery in King Faisal hospital, Taif, KSA. Heworked as specialist in general surgery in Alganzoury private hospital in Cairo, Egypt  from 2008 to 2014( part time)

He worked as consultant hepatopancreatobiliary and laparoscopic surgery in King Khaled hospital (General surgery and trauma hospital) in Hail in KSA for 6 months (Locum) from 2/ 2015 to 8/2015. He worked as consultant general surgery in Alnile hospital, Gherghada, Egypt from 3/2016 until 8/2016.

Abstract:

Objectives: Laparoscopic cholecystectomy (LC) - associated bile duct injury (BDI) is a clinical problem with poor outcome. The study aimed to analyze the outcome of surgical management of these injuries. Patients and methods: We retrospectively analyzed 69 patients underwent surgical management of LC related major BDIs (MBDIs), in the period from mid 2013 to mid 2018. Results: Regarding injury type; the Leaking, Obstructing, leaking + obstructing, leaking + vascular, and obstructing +vascular injuries were 43.5%, 27.5%, 18.8%, 2.9%, and 7.2% respectively. However, the Strasberg classification of injury was as follow:  E1=25, E2=32, E3=8, and E4=4. The definitive procedures were as follow: End to end biliary anastomosis with stent, hepaticojejunostomy (HJ) with or without stenting, and RT hepatectomy plus biliary reconstruction with stenting in 4.3%, 87%, and 8.7% of patients respectively. According to time of definitive procedure from injury; the immediate (before 72 h), intermediate (between 72 h and1.5months), and late (after1.5 months) management were 13 %, 14.5 %, and 72.5 % respectively. The hospital and 1month (early) morbidity after definitive treatment was 21.7 %, while, late biliary morbidity was 17.4 % and the overall mortality was 2.9%, on the other hand, late biliary morbidity free survival was 79.7%. On univariate analysis, the following factors were significant predictors of early morbidity; Sepsis at referral, higher Strasberg grade, associated vascular injury, RT hepatectomy with biliary reconstruction as a definitive procedure, intra-operative bleeding with blood transfusion, liver cirrhosis and longer operative times and hospital stays. However, the following factors were significantly associated with late biliary morbidity: Sepsis at referral, end to end anastomosis with stenting, Reconstruction without stenting, liver cirrhosis, operative bleeding and early morbidity. Conclusion: Sepsis at referral, liver cirrhosis and operative bleeding were significantly associated with both early and late morbidities after definitive management of LC related MBDIs, so it is crucial to avoid these catastrophes when doing those major procedures.  

 

Biography:

His name is Hardi, born on 14:01:1989. He know 6^th languages: English, Russian, Arabic, Kurdish, Persian and Turkish. He have beign studied in Salahadin state university in Iraq, South Ural state university in Russia and now he is 6^th year student in Saratov state medical university in Russia ;faculty:general medicine in English medium. He had many practice and experience about medical emergency, now he is interested to come to netherland on june and make poster presentation about about effect of aging on digestive diseases.

Abstract:

The aging process has clinically significant effects on oropharyngeal and upper esophageal motility, colonic function, gastrointestinal (GI) immunity, and GI drug metabolism ,On the other hand, because the GI tract exhibits considerable reserve capacity, many essential aspects of GI function, such as intestinal secretion, are preserved with aging.Despite such adaptation, superimposed effects of chronic diseases and environmental(lifestyle)exposures (medications,alcohol, tobacco) can further impair GI function in older patients.A modest decline in gastric mucosal cytoprotection or esophageal acid clearance may become significant when superimposed side effects of certain medications or concurrent disease are also present. Certain age-related changes in GI function, such as constipation, are viewed as dysfunctional by patients and health care providers. Research areas that have been identified as important in aging include the pathophysiology of swallowing disorders, esophageal reflux, dysmotility syndromes,GI immunobiology, and the cellular mechanisms of neoplasia in the GI tract.Animal studies provide important insights into the cellular physiology of aging, despite the issue of species variation.The increasing likelihood of dental decay and tooth loss with aging affects the efficiency and completeness of mastication ,Chewing and swallowing are impaired by xerostomia, which affects roughly 25% of older patients, while as many as 50% have subjective complaints of dry mouth. Medication side effects are a common cause of xerostomia, while a minority is caused by specific diseases affecting the salivary glands, such as Sjogren's syndrome. A mild loss of saliva production appears to occur with normal aging.After food is broken up in the mouth by mastication, the act of swallowing moves the food bolus from the oral cavity into the pharynx and esophagus ,The oral and pharyngeal stages of swallowing are regulated by cortical input to medullary swallowing centers, which innervate skeletal muscle groups in the pharynx. The proximal esophagus contains skeletal muscle controlled by nerves from the medullary swallowing centers, whereas the mid- and distal esophagus consists of smooth muscle regulated by intrinsic enteric innervation and extrinsic innervation by the vagus nerve. Oropharyngeal swallowing disorders are most commonly observed in patients with cognitive and/or perceptual dysfunction secondary to stroke or dementia, or chronic neurodegenerative diseases that affect the brainstem or motor neurons, such as Parkinson disease,myasthenia gravis,or amyotrophic lateral sclerosis. Normal aging, however, is associated with alterations that predispose older individuals to dysphagia. Video fluoroscopy demonstrates abnormal transfer of a food. 

Biography:

Enqiang Linghu is the Director of Department of Gastroenterology and Hepatology of China PLA General Hospital. In 2004, he further studied in Endoscopy Center of Massachusetts General Hospital and got his MD degree in 2008. He is successor President of Chinese Society of Digestive Endoscopy (CSDE), Director of Gastroesophageal Varices Academical Group of CSGE and successor President of Beijing Medical Society of Digestive Endoscopy. He is a famous Expert of Digestive Endoscopy domestically and internationally, especially good at ERCP, EUS diagnosis and treatment for pancreatic cystic lesions and digestive endoscopic tunnel techniques (POEM, STER and ESTD).

Abstract:

The digestive endoscopic tunnel technique (DETT) is utilized to establish a “tunnel” of the digestive tract; thus, many diseases calling for surgical treatment previously can be treated by digestive endoscopic therapy, which is superior to surgical treatment with minimal invasion and faster post-operative recovery rate. Emergence of the DETT has boosted endoscopic treatment, as a milestone significantly expanding its range. The DETT based on such technique has gradually developed with plenty of improvements and has been carried out in numerous hospitals successively worldwide. At present, no consensus has been reached about the indications, contraindications, intraoperative endoscopic operation specifications and patient's perioperative treatment for this technique.

The principle of DETT is quite simple and shown as follows: DETT divides the digestive tract wall into 1 to 2 layers (mucous and MP) and maintains the integrity of mucous or MP to isolate the digestive lumen and other body lacunas, thus avoiding the entry of gas and digestive fluids while guaranteeing the integrity of the anatomical structure during treatment

In recent years, the advanced evidence-based medical research achievements have sprung up constantly, promoting the rapid development of endoscopic tunnel technique. Hence, it is urgent to formulate a Consensus on Digestive Endoscopic Tunnel Technique, in which the level of evidence (adopted in evidence-based medicine) will be classified, with recommendation levels also listed

Biography:

Danilov Mikhail has completed his PhD at the age of 28 years from Center of Surgery named after acad. B.V.Petrovsky, and postdoctoral studies from Sechenov University. He is the senior researcher of department of colorectal surgery. He has published more than 70 papers in reputed journals.

Abstract:

Intestinal intussusception is a very rare pathology, especially in adults. The causes of intestinal intussusception can be both benign and malignant neoplasms. Often, intestinal intussusception is an occasional diagnostic finding, but cases of clinically significant invaginations that lead to disruption of the intestinal passage are described. Significant diagnostic contribution is made by ultrasound and endoscopy, but sometimes one has to resort to such diagnostic methods as CT and MRI. The tactics of surgical treatment of intestinal intussusception are different, and can vary from conservative intussusception to an expanded resection of the intestine site. In this clinical example, the case of ileo-cecal intussusception is described on the background of metastasis of melanoma in the ileum.

Сolonoscopy - in the ascending colon, the invaginated small intestine, occupying 2/3 of the lumen (15 cm in length), is defined in the terminal part of the small intestine with a diameter of about 4 cm.

CT of abdomen - intussusception of the terminal part of the ileum into the cecum and ascending colon, the blood flow at the level of the invaginate is traced.

Operation - right-sided hemicolectomy with D-3 lymphadenectomy (taking into account the absence of morphological verification of the tumor and the impossibility of excluding malignant lesions).

Histological examination - pigment-free metastasis of melanoma, there are no metastases in 29 lymph nodes, expression of S100, CD117, HMB45 Melan A is determined in tumor cells.

Biography:

Loh Wei-Liang is a Senior Resident of General Surgery in Singhealth, Singapore. He has interests in surgical oncology, endoscopy, and medical education. Outside of work, he loves to travel and experience new cultures.

Abstract:

Difficult and large common bile duct stones can be crushed and removed using a mechanical lithotripter. Very often the lack of working space within the common bile duct causing the failure of mechanical lithotripsy would inevitably mean repeat or further invasive procedures. We herein describe a novel and ingenious technique of utilizing a through-the –scope (TTS) dilator in helping to expand the space within the common bile duct to allow for full deployment of a mechanical lithotripter and successful clearance of common bile duct stones. This ingenious method can be easily applied by advanced endoscopists and is expected to lead to increased success rates of clearance of difficult common bile duct stones.

Biography:

Professor Zoya Vinokur is an alumn of New York City College of Technology. Professor Vinokur teaches Radiographic Procedures and Clinical Education. She received her Bachelor of Science degree from Long Island University, C.W. Post, her Master of Science degree in Health Services Management and Policy from New School University and holds advanced certification in mammography.

With over 20 years of professional  and teaching experience she has taught a variety of courses in the medical imaging discipline including, Radiographic Procedures and Positioning, Pediatric Radiography,  Advanced Medical Imaging II in a baccalaureate degree program, and Clinical Education. Professor Vinokur worked in major Metropolitan Hospitals in New York and New Jersey she brings her extensive knowledge and background to the classroom as well as in to clinical settings. She is licensed to practice in both New York and New Jersey States.

Professor Vinokur is a frequently invited speaker at professional conferences both locally and regionaly. Her areas of concentration and interest include Teaching and Technology
Chalenges , Mammography, and MusicTharapy. Work in Progress: “Effects of Musical Therapy Interventions on Mammography Outcomes. Specialties: Mammography, CT, MR, PACS/ RIS. She currently serves on various Educational Advisory Boards and has held other Board positions in professional organizations including Vice President,Coresponding Secretary, and Nominating Chair.

Abstract:

Cultural competence is defined as the ability of providers and organizations to effectively deliver equitable and unbiased health care that meet the social, cultural, and linguistic needs of a culturally diverse patient body.  By 2050, minority populations will increase to 48 percent of the U.S. population and Hispanics will represent 24.4 percent of the total population (U.S. Census, 2010). This demographic shift brings challenges and opportunities to universities and organizations alike to create policies and curriculums that foster quality health care amongst students, while also contributing to the eradication of implicit biases that may unwittingly perpetuate healthcare disparities amongst racial and ethnic minority groups.  Our research looks to answer the critical question of whether or not health care students are adequately prepared by their universities to deliver healthcare services that are culturally competent and sensitive? Are students aware of the importance of implicit biases and what measures can be taken on an institutional level to ensure that healthcare students are adequately prepared to deliver equitable healthcare to all minority groups.  This study looks to gauge the understanding of cultural competence amongst a group of City Tech healthcare students by utilizing a cross-cultural survey of cultural competence questions dealing with poverty, age, stereotypes, illiteracy, homophobia, language, religion, and racism. Our data and research results suggest that many health care students are not able to properly define, nor fully implement cultural competence and sensitivity in their clinical settings. This data is significant because administrators and educators need to incorporate more learning strategies and relevant clinical training so that students may enter the work force better equipped to deliver the highest quality of care to all patients, regardless of race, ethnicity, cultural background, English proficiency or literacy.

Biography:

Marwa works as a radiology resident and is now enrolled in the masters degree program in Alexandria university, Egypt.

Abstract:

Aim

To identify imaging features of neoplastic porta hepatis lesions of vascular and non vascular origin using CT and MRI

Methods & Results

The main indication for imaging referral was chronic right hypochondrial pain. We retrospectively analyzed 30 cases of porta hepatis lesions with age ranging between  (22-80) years, (mean age 55 years) explored by:

• Multi-phasic CT using xx row detector multi-slice CT, 3 phase contrast protocol

• MR cholangiography using a 1.5 T closed MRI

• Liver MRI using a 1.5 T closed MRI

Regarding the anatomical origin of the PH-lesions we divided them to lesions of vascular and non vascular origin. Regarding the final diagnosis; vascular lesions included portal vein thrombosis, encasement of the common hepatic artery, and common hepatic artery aneurysm (n=12), non vascular lesions namely cholangio-carcinoma, metastatic lymphadenopaties and non Hodgkin's lymphoma (n=10) and combined vascular and non vascular lesions (n=8)

We opted for a structured report commenting on status of the liver parenchyma, gall bladder, common bile duct and common hepatic ducts, vascular structures status (i.e. portal vein, common hepatic artery) and lastly nodal status.

Conclusions

Imaging of the porta hepatis is challenging and complex with wide spectrum of malignant pathologies of different origins. Familiarity with the pathogenesis and imaging features as well as structured reporting algorithm can aid the radiologic diagnoses and guide appropriate patient management.

Biography:

Mona works as a radiology resident and is now enlisted in the master’s degree in Alexandria University, Egypt.

Abstract:

Aim

To study the role of MDCT angiography in assessment of the variations in celiac arterial trunk (CAT) and hepatic arterial system (HAS), which are of considerable importance in liver transplantation, laparoscopic surgeries, abdominal interventions , TACE and abdominal penetrating injuries.

Methods & Results

We prospectively studied 312 patients presenting with abdominal pain with age ranging between 4-85 years imaged by:

• MDCT scans including non-enhanced phase and post-contrast Arterial phase (25-30 seconds after contrast injection).

          Regarding the CAT and/or HAS variations 100 patients were documented, from which:

• 8 patients had isolated variations in CAT,

• 64 patients had isolated HAS variations

• 28 patients had CAT variations associated with HAS variations.

The most commonly noted variant in CAT was gastro-splenic (20 cases), while the most commonly noted variant in HAS was replaced right hepatic artery from SMA (34 cases).

We adopted a new method for categorizing the different caeliac and hepatic arterial variants into a new comprehensive classification.

Conclusions

The celiac axis and its branches are critically important arteries that supply blood to the vital solid and hollow abdominal viscera of the foregut. There are many potential anatomic variants. MDCT angiography is widely used as the first step in evaluation. Our comprehensive classification can easily help with the final imaging diagnoses and thus proper patient treatment.