Upper Gastrointestinal Tract. Dr. Pascal Juillerat, M.Sc. epidemiology Gastroenterology, clinic for visceral surgery and medicine Inselspital, Bern

Transcription

1 Upper Gastrointestinal Tract Dr. Pascal Juillerat, M.Sc. epidemiology Gastroenterology, clinic for visceral surgery and medicine Inselspital, Bern

2 ?

3 MONDAY Text GENETICS OR OR

4 ENDOSCOPICAL IMAGING Volumetric Laser Endomicroscopy: balloon-based OCT imaging technique that provides a 6-cm long circumferential volumetric scan of the esophageal wall layers to a depth of 3 mm with a resolution comparable to low-power microscopy. OCT : Optical coherence tomography employs near-infrared light (= relatively long WL)

5 ENDOSCOPICAL IMAGING VLE: Volumetric Laser Endomicroscopy Method : one-to-one correlated histology-vle images, in 52 Endoscopic resections from 29 Barrett Esophagus patients. Histological diagnoses : 16 early adenocarcinoma, 5 high-grade dysplasia (HGD), 2 low-grade dysplasia (LGD), 6 non-dysplastic (ND) BE. Results : 86 histology-vle matches were constructed including 185 areas of interest : - 60 % non-dysplastic : squamous, gastric or non-dysplastic BE, - 40% dysplastic: 13% LGD, 12% HGD, 15% early adenocarcinoma. Predictive for dysplasia: lack of layering, homogeneity and irregular glands. Development of the first atlas of potential VLE features for early BE neoplasia.

6 TUESDAY Text F2

7 SYMPOSIUM

8 Plennary session «the OMICS» GENOMICS Sydney, Australia Human Papilloma Virus Cervix and laryngeal Carcinoma? Esophageal Carcinoma?

9 GENOMICS As for cervix Ca A Role of hr-hpv infection in the Barrett s metaplasia dysplasia adenocarcinoma sequence? Clinical Gastroenterology and Hepatology, July 2015 «A link between HPV and esophageal squamous cell carcinoma seems possible, although the associations with esophageal adenocarcinoma are not conclusive»

10 GENOMICS Sydney, Australia 12 Esophageal adenocarcinoma : 4 hr- HPV pos. vs. 8 neg. Method: whole exome sequencing Results: distinct genomic differences between HPV-positive and HPV-negative Esophageal carcinoma suggesting different biological mechanisms of tumour formation. Even if HPV is not a causative agent for Barrett s esophagus, better define whether HPV positivity is associated with more aggressive / refractory disease

11 Text DRUG TRIAL Date: Time: Room: No. OP/P: Madrid, Espagna prevalence of Clarithromycin resistance : if >20% Quadruple therapy (1) Bismuth containing : PPI-BMT (deboer, 1996) (2) Non- bismuth concomittant : PPI-AMC (Treiber, 1998) (3) sequential : PPI-AMC (Zullo, 2000) A= amoxicilin B = bismuth C = clarithromycin M= metronidazol T= tetracyclin Maastricht IV recommendations Malfertheiner Gut 2012,61:646-64

12 Text DRUG TRIAL Date: Time: Room: No. OP/P: Madrid, Espagna N= 1000 consecutive patients ( 370 / 630) ; Country : spain. Comparison of 2 types of non-bismuth concomitant first-line quadruple therapies CONC10 (standard): OME20, + ACM for 10 days ; CONC14+ : ESO40, + ACM 14 days Outcome: efficacy = eradication w/ BT - ; AE Results : ITT cure rates : 87% and 91% (p<0.05) ; AE: 34% vs. 46% (p<0.05), (metallic taste, diarrhea, nausea and abdominal pain) Optimization (14-day and high-dose esomeprazole) => more effective > 90% cure rate. More adverse events, but mostly mild, and no impact on compliance.

13 Text Motility Date: Time: Room: No. OP/P: Lyon, France Case example : 31 yo male, 3 years after SL

14 Text Motility Date: Time: Room: No. OP/P: Lyon, France high resolution manometry together with impedance (HRMI) in 24 pts, 3 mo post surgery. Results and Conlusion : 75% of increased intra-gastric pressure (during 5 ml-swallows) (= decrease of the compliance of the gastric pouch) independent of digestive symptoms, 50% of reflux episodes significantly associated with typical GERD symptoms, hypotonic esophageal peristalsis and a smaller volume of the gastric pouch. HRMI may thus be useful for the diagnosis of GERD after SG. and in particular before bariatric surgery! Tutuian R. Curr Opin Gastroenterol 2014, 30:434 8

15 Text Endoscopic Myotomy Date: Time: Room: No. OP/P: Roma, Italia Per-Oral Endoscopic Myotomy (POEM), for the treatment of achalasia N= 64 POEMs Follow up report 2 years at Catholic University, Rome, Italy. Source: Prof. Bauerfeind Forum Med Suisse 2014;14(51 52):

16 Text Endoscopic Myotomy Date: Time: Room: No. OP/P: Roma, Italia Per-Oral Endoscopic Myotomy (POEM), for the treatment of achalasia N= 64 success rate Results : univariate analysis: no predictive factors of success Except : maybe myotomy on the gastric side was significantly longer in non-relapsers (3.5cm vs 2.75cm, p<0.05). Pneumatic dilatation (50% success) 0.8 patients at risk > 50% had abnormal acid exposure: 20% heartburn / 17% Esophagitis efficacy of POEM for the management of achalasia also at a mid-term-follow-up, but decrease with time. A long myotomy (>3cm) on the gastric side is likely associated with better outcomes

17 By the way

18 Text Date: Time: Room: No. OP/P: PHARMACOEPIDEMIOLOGY 2 hypotheses: for risk of pneumonia with PPI 1. Removes the normal defence mechanism against ingested bacteria and spores which could favour infections (potential protective effect on upper pulmonary airways) and modified gut bacterial composition! * Thorens et al, Gut Effects on the immune system Nottingham, UK PPI : may impair innate immunity by neutrophil functions such as chemotaxis, and degranulation and in Lausanne CHUV : with F. Froehlich, AL Blum, JJ Gonvers and M Fried. interfer with the oxidant-producing system, thus decreasing lyzosomal and bactericidal activity Wandal l et al, Gut Suzuki M, et al Biology and Medicine Zedtwitz-Liebenstein K, et al Crit Care Med Jutel M et al. Clin Exp Allergy 2009.

19 Text Date: Time: Room: No. OP/P: PHARMACOEPIDEMIOLOGY Nottingham, UK

20 Text Date: Time: Room: No. OP/P: SURGICAL TECHNIQUE Milano, Italia VS. Laparoscopic surgery :

21 Text Date: Time: Room: No. OP/P: SURGICAL TECHNIQUE Milano, Italia between March 2007 and December LINX and 97 LTF VS. Reoperation rate was 7% in LINX and 2% in LTF (p=0.13) Results : similar 7-year Fup - GERD-HRQL scores (OR 1.01 CI , p=0.80) - PPI use (14% of LINX and 11% of LTF, p=0.7). - incidence of dysphagia (9% of LINX and 9% of LTF, p=0.89) - bloating (OR 0.69 CI , p=0.54) possible paradigm change and a new concept of antireflux surgery

22 WEDNESDAY Date: Time: Room: No. OP/P:

23 Text Biomarker Validation Date: Time: Room: No. OP/P: Padova, Italia Validation of SCCA IgM (ELISA) as biomarker for Barrett / adenocarcinoma N= 231; blood from 53 Barrett, 53 adenocarcinoma & 71 controls Results: SCCA-IgM values higher in BE and EAC (p<0.0001). Above the calculated cut-off value 33x higher Relative Risk (p=0.0001). Patients at risk (long or dysplastic BE) had SCCA-IgM levels significantly higher than those with short non-dysplastic BE (p=0.035) Serum SCCA-IgM determination allows the identification and stratification of patients at risk for Barrett s esophagus and esophageal adenocarcinoma, them.

24 Monday Tuesday PLENNARY SESSION ENDOSCOPICAL IMAGING EoE SYMPOSIUM GENOMICS Wednesday Biomarker Validation Motility Endoscopic Myotomy SURGICAL TECHNIQUE DRUG TRIAL PHARMACOEPIDEMIOLOGY