International Conference on Digestive Diseases December 08-09, 2016 Dubai, UAE

Biography:

R C Luciani has completed Ph.D. from the University Claude Bernard Lyon France in 1988. He has published papers in the field of laparoscopy including colo-rectal surgery nephrectomy and hepatectomy since 1991. He has been a speaker at IRCAD WebSurg Strasbourg France and a founding member of MGB /OAGB club. He is at present mostly involved in bariatric metabolic surgery. 

Abstract:

Many recent prospective studies have undoubtedly proven metabolic surgery to be the most effective treatment of T2DM compared with medical management. Therefore bariatric surgeons have now to question the best surgical procedure to achieve diabetes improvement or even resolution not only in severely obese patients but also in mildly obese ones without exposing them to the risk of malnutrition. To achieve this goal, metabolic surgery can surely benefit from the previous results of general surgery in regards to the very different effects of the various types of reconstruction after gastrectomy (Billroth I versus Billroth II and Roux en Y) both in diabetic and nondiabetic patients. This presentation reviews the results of general and oncological gastric surgery and their implications in the field of diabetology. According to these data duodenal diversion reconstruction after gastrectomy significantly improves T2DM in diabetic patients while it seems on the opposite to worthen glucose metabolism in non-diabetic ones. These conclusions should lead to excluding restrictive procedures without duodenal diversion in the surgical management of T2DM avoiding much malabsorption and weight loss in thin diabetic patients 

Biography:

Khalifa Almulhim has completed his PhD from College of Medicine in King Faisal University, Dammam. He has completed Saudi board in General Surgery in 2005 and obtained Saudi Fellowship in Colorectal Surgery. He is working as a consultant Colorectal Surgeon. He is the Member of Review Board in Oman Medical Journal and also Member of the Saudi Colorectal Surgery Society.

Abstract:

Case Report: 19 years old male was presented with symptoms and signs mimicking abdominal TB. His workup showed marked Eosinophilia and an inflammatory mass in the right side of the colon.  Pathology obtained by colonoscopy confirmed active eosinophilic colitis and treated accordingly by Gastroenterologist. Nevertheless, his condition worsened in the form of intestinal obstruction. Radiologic investigations showed obstructed cecal lesion with apple core appearance and right hemicolectomy was performed. Final result has been proved to be gastro-intestinal basidiobolomycosis.

Biography:

Muhammad S Niam is a General Surgeon, a Consultant in Digestive Surgery and also an Endoscopic and Laparoscopic Surgeon. He is a Lecturer and Medical Staff of Saiful Anwar General Hospital/Brawijaya University School of Medicine, Malang, Indonesia. He is a Chairman of Indonesian Society of General Surgery of Malang Region, National Faculty Member of Indonesian Society of Endo-laparoscopic Surgery, National Faculty Member of Indonesian Society of Coloproctology and Committee of Asian Society of Colorectal Surgery.

Abstract:

Laparoscopic colorectal cancer resection requires another abdominal incision to extract the resected specimen. We describe a technique for laparoscopic resection of an upper rectal cancer in a 50-year-old man followed by transanal specimen delivery, hence avoiding the need for making any additional abdominal incisions for retrieval of the specimen. Pneumoperitoneum was created, followed by medial-to-lateral mobilization of the sigmoid colon and take down of the splenic flexure and division of the inferior mesenteric vessels laparoscopically. The rectum distal to the tumor was tightly bounded extra-luminally by gauze tape and transected after distal intraluminal irrigation through an anal opening under direct vision by transanal rigid endoscopy. The proximal stump was extracted transanally via an opening in the rectal stump. The proximal colon was then transected extra-corporeally and the anvil of the circular stapler inserted before returning it to the pelvic cavity. The distal rectal stump was circularly sutured and the colorectal anastomosis was then completed intracorporeally. The patient with an annular rectal cancer 10cm from the anal verge underwent that procedure. Postoperative recovery was uneventful. He has resumed normal daily activities 1 week after surgery. Histopathology confirmed a moderately differentiated T3N0 upper rectal adenocarcinoma. In the effort to minimize surgical trauma and postoperative pain, natural orifice specimen extraction techniques have been attempted. This procedure may be applicable to benign tumors and early colorectal cancer and serves as an intermediate step between laparoscopic and natural orifice endoscopic surgery.

Biography:

Ali Al Ghrebawi is currently working in Colorectal Surgery Department, Meppen-Germany.

Abstract:

Most of the surgeons are now convinced of the benefits of the laparoscopic approach in colorectal surgery. The laparoscopic approach for benign and malignant colon disease is safe, feasible and effective. More challenging is the adoption of this approach while addressing colorectal cancer disease and maintaining oncological principles. After performing a standard laparoscopic surgery technique in benign and malignant diseases for several years, we are now moving one step forward. The laparoscopic approach was used for all benign and malignant colorectal diseases. To reduce the number of trocars and avoid a 5cm incision for specimen extraction, we started to utilize the “Reduced Port” technique while dealing with rectal cancer. Performing the TME safely, respecting all oncological principles whilst following the surgical guidelines of the European surgical societies, the OCTO-Port® was utilized at the site of the Loop Ileostomy, which was marked before the operation. In addition, a 5mm Transport® trocar was inserted in the lower third of the abdominal wall. The operation steps are generally equivalent to a standard Laparoscopic approach. At the end of the operation, the specimen is extracted through the wound retractor of the OCTO-Port®, negating the need for an additional incision. The anastomosis is performed with a Compact CS®. According to the latest and most relevant study, COLOR II which involved 30 Hospitals in 8 countries, along with our own study, we can approve the safety and accuracy of this approach in comparison with the classic open approach when dealing with rectum cancer.

Biography:

Brianna Twomey is currently working in St. Vincent's Hospital, Melbourne, Australia.

Abstract:

Biography:

Vikas Leelavati Balasaheb Jadhav has completed Post-graduation in Radiology in 1994. He has 19 years of experience in the field of gastrointestinal tract ultrasound & diagnostic as well as therapeutic interventional sonography. He has four Indian Patents and an International Patent published on his name in the field of gastrointestinal tract sonography & radiology, since 2008. He has delivered many lectures in Indian as well as International Conferences in nearly 20 countries as an invited guest faculty, since 2000. He is a Consultant Radiologist & Specialist in Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

Transabdominal sonography of the stomach & duodenum can reveal many diseases like gastritis & duodenitis, acid gastritis, ulcer, whether it is superficial, deep with the risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & struicture. polyps & diverticulum, benign intramural tumors, intramural hematoma, duodenal outlet obstruction due to the annular pancreas, gastro-duodenal ascariasis,  pancreatic or biliary stents, foreign body, necrotizing gastro-duodenitis, tuberculosis, lesions of the ampulla of vater like prolapsed, benign & infiltrating mass lesions. The neoplastic lesion is usually a segment involvement, & shows irregularly thickened, the 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 with enlargement of the involved segment. The shouldering effect at the ends of stricture is the most common feature. Enlarged lymph nodes around may be seen. Primary arising from the wall itself & secondary are the invasion from periampullary 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 gastrointestinal tract lesions, so should be the investigation of choice.

Biography:

Vikas Leelavati Balasaheb Jadhav has completed Post-graduation in Radiology in 1994. He has 19 years of experience in the field of gastrointestinal tract ultrasound & diagnostic as well as therapeutic interventional sonography. He has four Indian Patents and an International Patent published on his name in the field of gastrointestinal tract sonography & radiology, since 2008. He has delivered many lectures in Indian as well as International Conferences in nearly 20 countries as an invited guest faculty, since 2000. He is a Consultant Radiologist & Specialist in Unconventional Gastro-Intestinal Tract Ultrasound & Diagnostic as well Therapeutic Interventional Sonologist in Pune, India.

Abstract:

Trans-abdominal sonography of the small & large intestines can reveal many diseases like bacterial & viral entero-colitis, an ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & structure. polyps & diverticulum, benign intra-mural tumours, intra-mural haematoma, intestinal ascariasis, foreign body, necrotizing entero-colitis, tuberculosis, intussusception, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, complications of an inflammatory bowel disease – perforation, structure. 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 with enlargement of the involved segment. Shouldering effect at the ends of stricture is most common feature. Primary arising from wall itself & secondary are invasion from adjacent 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.Trans-abdominal sonography of the small & large intestines can reveal many diseases like bacterial & viral entero-colitis, an ulcer, whether it is superficial, deep with risk of impending perforation, perforated, sealed perforation, chronic ulcer & post-healing fibrosis & structure. polyps & diverticulum, benign intra-mural tumours, intra-mural haematoma, intestinal ascariasis, foreign body, necrotizing entero-colitis, tuberculosis, intussusception, inflammatory bowel disease, ulcerative colitis, Crohn’s disease, complications of an inflammatory bowel disease – perforation, structure. 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 with enlargement of the involved segment. Shouldering effect at the ends of stricture is most common feature. Primary arising from wall itself & secondary are invasion from adjacent 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:

Marwa El-Hossarya is currently working in Department of Tropical Medicine, Tanta University, Tanta, Egypt

Abstract:

Background

Endoscopic surveillance of oesophageal varices (OV) in cirrhotic patients is expensive and uncomfortable for  the patients. Therefore, there is a particular need for noninvasive predictors for OV.

Objective

The aim of the present study was to evaluate the accuracy of ultrasound indices and blood indices as noninvasive OV predictors among cirrhotic patients. Patients and methods A total of 61 cirrhotic patients were enrolled in this study and were divided into two groups: 21 patients without OV and 40 patients with OV who were further subdivided into 24 patients with small OV and 16 with large oesophageal varices (LOV). P2/MS, serum fibrosis markers (APRI, FIB4, Lok score, and Forns index), abdominal ultrasonography [portal vein diameter (PVD), splenic index], platelet count/spleen diameter ratio (PC/SD), and Doppler ultrasonography [portal vein velocity, splenoportal index, hepatic and splenic impedance indices, and hepatic venous waveform (HVWF)] were assessed in all patients.

Results

P2/MS was the best predictor of OV and LOV [area under the curve (AUC) 0.88 and 0.787, respectively] followed by PC/SD (AUC 0.77 and 0.715, respectively). PVD, serum fibrosis markers, and serum albumin had the least accuracy for OV prediction. For LOV predictions, Lok score had good accuracy (AUC 0.785) followed by serum albumin, PVD, APRI, and Forns index (AUC 0.72, 0.738, 0.734, and 0.738, respectively). Monophasic HVWF showed a good positive predictive value (85%) and specificity (80.95%) for prediction of OV and good sensitivity (81.25%) and negative predictive value (81.25%) for LOV.

Conclusion

P2/MS can identify OV and LOV in cirrhosis with high accuracy followed by PC/SD. Monophasic HVWF is a good noninvasive predictor of OV and LOV in cirrhotic patients.

Biography:

Asma Shabbir has a passion towards research and concerned for better prognosis oand also adores to teach the medical students. Her dissertation work involved evaluation of Her-2/neu in gastric and colorectal adenocarcinomas. The basis of which arised from the use of targeted therapy (α-Her-2) in breast cancer patients. Similarly, α-Her-2 therapy in gastric and colorectal cancer might give another treatment option for better prognosis to these patients in this new era of personalized medicine.

Abstract:

Background & Study Aim: Gastric cancer is the third leading cause of cancer mortality worldwide. Human epidermal growth factor (Her-2/neu) has shown strong therapeutic implication in breast cancer. Expression of Her-2/neu in gastric cancer has been reported from across the world, it is still unknown from South Asia region. The aim of this study is to evaluate Her-2/neu expression in gastric adenocarcinomas and to correlate with various clinico-pathological variables.

Patients & Method: A total of 95 consecutive patients undergoing endoscopic biopsy or gastrectomy were recruited in this study after institutional ethical approval. Clinico-pathological parameters of all patients were recorded and hematoxylin and eosin (H&E) staining was performed. Expression of Her-2/neu was investigated by immunohistochemistry using α-Her-2 antibody. Hofmann validation scoring system was used and its association was seen with various clinicopathological variables including age, gender, histopathological type, grade and stage of the tumor.

Results: Her-2/neu over expression was found in 21 (22.1%) cases from the total of 95 gastric adenocarcinomas. Her-2/neu was significantly expressed in low grade gastric cancer (p=0.030). Although there was no significant difference between Her-2/neu expression and other variables, Her-2/neu score 3+ was higher in females, age > 60 years, Laurens intestinal type & IIIC stage.

Conclusion: Her-2/neu is expressed in a limited group of gastric cancer patients in Pakistani population. Our findings indicate a significant strong association of Her-2/neu expression with low grades of gastric cancer.

Biography:

Madiha Amjad is a Doctor and obtained MBBS degree from Dalian Medical University, China in 2010. He then worked as House officer in Medicine and Surgery from 2011-2012. He worked as a Demonstrator of Anatomy for one year and started Post-graduation in Anatomy in 2014 from UHS, Lahore, Pakistan. He is also pursuing MHPE (Masters in Health professional Education) from UHS. His research interests are gastrointestinal pathologies, female genital tract pathologies, breast cancer and autoimmune diseases.

Abstract:

Statement of problem: The integrity of stomach mucosa is maintained by defense mechanism e.g. mucous secretion, mucosal blood flow, bicarbonate secretion, scavenging of free radicals and the gastric mucosal barrier against these damaging and aggressive factors. The peptic ulcer developed when the balance between aggressive and defensive factors occurs and situation favors aggressive factors enough to cause mucosal damage and lead to ulceration. Aspirin is extensively used as an analgesic and anti-inflammatory drug. It is safe in therapeutic doses but it is toxic in over dosage or in chronic injudicious use when it causes acute or chronic toxicity respectively. Acute toxicity causes gastric ulceration and bleeding. Many antioxidants have been trying to study their protective effects of NSAID-induced gastric ulcers. Coconut and its products are known for their antioxidant, antibacterial, antidiabetic, antithrombotic and antiulcerogenic effects. The present study was designed to observe the effect of ethanolic extract of coconut on aspirin-induced gastric ulcer in male albino rats. Two different studies are documented about the effect of ethanolic extract of coconut on Indomethacin-induced gastric ulcers. Both are paradoxical and show controversy at different doses of extract. The present study, therefore, designed in an attempt to observe the effects of high doses of ethanolic extract of coconut on aspirin-induced gastric ulcers. This study was conducted at University of Health Sciences Lahore.

Methods: Thirty (30) rats, weighing 175-220gm, were divided into six groups and treated with different doses of the Ethanolic extract of coconut for 14 days and was sacrificed on the 15^th day of the experiment. Methodology involved staining of the stomach with H&E and Masson-Trichome staining and observed for desquamation, mucosal congestion, inflammatory cells and necrosis. Blood samples were drawn for serum analysis of Super Oxide Dismutase (SOD).

Findings: The results showed that ethanolic extract of coconut helps to heal the stomach ulcers and gives best results at 400mg/kg dose and also helps to reduce oxidative stress which also helps to heal ulcers.

Conclusion & Significance: It was concluded that ethanol extract of coconut provides a very reliable and cost-effective adjunctive therapy to be routinely used in patients who take aspirin and aspirin-induced gastric ulcers as well.

Biography:

Mishal Sikandar is a Doctor and obtained MBBS from UHS, Pakistan in 2012. He worked as House officer in Medicine, Cardiology and Obs & Gynae in 2013. He then worked in Obstetrics and gynecology for one year and started Post-graduation in Morbid Anatomy and Histopathology, from UHS, Lahore, Pakistan. His research interests are cardiology, female genital tract pathologies, carcinoma breast, gastrointestinal pathologies, bone cancer and Hirschsprung's Disease. He has published articles in “Biomedica”, an official publication of University of Health Sciences.

Abstract:

Statement of Problem: Hirschsprung disease (HSCR) or congenital intestinal aganglionosis is a birth defect characterized by complete absence of neuronal ganglion cells from a portion of the intestinal tract, mostly in a segment of rectum and variable length of contiguous proximal, causing functional obstruction and colonic dilation proximal to affected segment. Routine diagnostic modalities like Hematoxylin & Eosin (H&E) and Acetylcholine Esterase (AChE) staining as well as radiology-based clinical techniques have been conventionally used for identification of aganglionosis and presence of hypertrophic nerve trunks in the affected segment as primary indicators of HSCR. However, these conventional methods have their inherent deficiencies as H&E requires multiple trans-mural biopsies and the interpretation of ganglion cells is often very difficult. Similarly, AChE requires fresh frozen section for which the chances of technical error are very high and this facility is not commonly available in Pakistan. The number of misdiagnosed results with potential overtreatment stands in need for reliable staining to prevent harm from unnecessary surgery and mortality. Recently, Immunohistochemical markers are being increasingly used and evaluated in Pathology laboratories. No immunohistochemical marker, either alone or in combination, has emerged from those researches that are as promising as calretinin. Hence, this study was designed with an aim to observe the immunohistochemical expression of Calretinin as a marker for aganglionosis and to detect ganglion cells in the affected areas for better and more accurate diagnosis of the disease.

Methodology: This study was conducted at University of Health Sciences Lahore, Pakistan from February to September, 2016. Colonic Biopsy Specimens from 73 patients were collected mostly from Mayo Hospital, Lahore with established histopathologic diagnosis of HSCR considered for the study. Age range was 0.1-120months. There were 48(65.8%) cases who were ≤12 months old, 20(27.4%) were 12.1-60 months old and 5(6.8%) of the cases were 60.1-120 month old.  The mean age of patients was 12.52±9.21 months. There were 52(71.23%) male and 21(28.77%) female patients. The male to female ratio in this study was 2.48:1. According to sign and symptoms and clinical examination, 69(94.5%) cases had mostly long standing constipation, 47(64.4%) cases had fever, 68(93.2%) cases had vomiting, 31(42.5%) cases had failure to thrive, 20(27.4%) cases had Enterocolitis and 63(86.3%) of the patients had palpable abdominal masses. Methodology involved staining of fresh sections with H&E procedure for provisional histological diagnosis. The biopsies were then processed for immunohistochemical staining with Calretinin and were observed for presence of ganglion cells.

Findings: All the ganglion cells took brownish-black stain and were easily identified, which were not being identified on H&E. Ganglion cells were present and absent in 42(57.53%) and 31(42.47%) respectively. The study revealed that the Calretinin immunohistochemistry was very sensitive and specific for detecting ganglion cells.

Conclusion & Significance: It was concluded that Calretinin provides a very reliable and cost effective adjunctive test to be routinely used with H&E in the evaluation of Rectal Section Biopsies (RSBs) for HSCR. The use of Calretinin may help the Pathologists in making accurate and reliable diagnosis for HSCR and consequently eliminating the need for repeated biopsies and unnecessary surgeries.    

Biography:

Nouf Suliman Alballa is a 4^th year Medical Student at King Saud University, Riyadh, Saudi Arabia. His research project has been supervised by Dr. Sami Al-Nassar, Head and Division of Thoracic Surgery at King Saud University- Medical City, Saudi Arabia. He is working on two other research projects.

Abstract:

Aim: Aim of this study is to determine the impact of laparoscopic Heller myotomy on patients’ symptoms with esophageal achalasia by evaluating pre-operative and post-operative Eckardt’s score.

Method: The patients involved in this study were diagnosed with esophageal achalasia and underwent laparoscopic Heller myotomy (LHM) between 2008 and 2015, at King Saud University- Medical City, Saudi Arabia. Record of 25 patients who underwent LHM was reviewed; out of these only 19 patients met the inclusion criteria who were included to conduct a retrospective cohort designed study. Patients’ demographic data, time of admission, hospital stay and surgical complications were obtained through Hospital Information System (HIS). Clinical symptoms were assessed using the Eckardt’s score, which is the sum of the individual symptom score for dysphagia, regurgitation, retro-sternal pain and weight loss. The pre-operative score was collected before the surgery in the surgical clinic. The post-operative score was collected by contacting the patients via telephone. The post-operative Eckardt’s score was recorded twice; first, between 3 to 6 months after the surgery and second, at the time of the phone call (January 2016).

Results: A total of 19 patients were included in the study with a mean age of 36.6 years, 13 of them were males (68.4%). The mean of the pre-surgical Eckardt’s score was 6.2 which was improved to 1.3-2.5 after laparoscopic Heller myotomy (P<0.01), with a clinical remission of 84.2% after the surgery.

Conclusion: Laparoscopic Heller myotomy is an effective procedure in achalasia patients with clinical remission of 84.2%.

Biography:

Hemant Atri has completed his MBBS from P.D.U. Medical College, Rajkot, Gujarat and currently pursuing Post-graduation in DNB Surgery at Fortis Escorts Hospital, Faridabad, India.

Abstract:

Dieulafoy’s lesion is a relatively rare, but potentially life-threatening, condition. It accounts for 1-2% of acute gastrointestinal (GI) bleeding, but arguably is under-recognized rather than rare. Extra-gastric Dieulafoy’s lesions are even more uncommon. We report the case of a 92-year-old male who presented with gastrointestinal bleeding from a transverse colonic Dieulafoy’s lesion. He presented with multiple episodes of melena followed by one episode of fresh blood per rectum. In addition, there was associated pre-syncope and anemia. Upper GI endoscopy was negative for an upper GI source of bleeding but on colonoscopy an actively oozing Dieulafoy’s lesion was identified in the ascending colon. Bipolar cautery and two hemostatic endoclips were applied to achieve hemostasis. Clinicians should consider this rare entity as a potential cause of potentially life-threatening lower gastrointestinal bleeding.

Biography:

Ashraf Othman Saleh Sayed has completed his Bachelor’s degree of Medicine in 1990 and Master’s degree of Pediatrics in 1995 from Faculty of Medicine, Minia University, Egypt. He has finished a two-year Pediatrics Fellowship and Doctor degree (MD) at Pediatric Intensive Care Unit (PICU), Royal Hospital for Children; Bristol University, UK in 2002. He has also received a Membership of Royal College of Pediatrics in 2001 (London, UK). He serves as an Assistant Professor of Pediatrics since 2006 at Faculty of Medicine, Minia University. Egypt. He has published more than 12 papers in reputed journals. 

Abstract:

Aim of the study: To measure the carotid intima-media thickness (CIMT) by high resolution ultrasound in children with diabetes type-1 for early detection of atherosclerosis and its association with other vascular risk factors including lipid profile, blood pressure, duration of diabetes and body mass index (BMI).

Methods: 25 children with diabetes type-1 and 20 healthy children matched for age, gender, and body size as the control group were recruited. Student’s t-test, Pearson’s correlation coefficient and multiple regression analysis were used for statistical analysis.

Results: Diabetic children have higher cIMT (P=0.0001) compared to controls. cIMT significantly correlates with age (r=0.73), duration of diabetes (r=0.57), BMI (r=0.59), diastolic blood pressure (DBP) (r=0.40), low density lipoprotein (LDL) (r=0.30), glycosylated hemoglobin A1c (HbA₁c) (r=0.34) and triglycerides (TG) (r=0.38). With multiple regression analysis in the diabetic group with high cIMT, the most significant factors affecting cIMT were duration of diabetes (β=0.997, P=0.02), daily insulin dose (β=0.729, P=0.044), total cholesterol (TC) (β=6.345, P=0.031); however, high density lipoprotein (HDL) was a negatively associated factor (β=-2.445, P=0.019).

Conclusion: Assessment of the cIMT is a non-invasive valuable assessing the structural status of the vascular system in diabetic children at increased risk for cardiovascular complications even in the early stages of atherosclerosis with absence of clinically apparent macro-vascular manifestations.

Biography:

Lui Ka Luen completed his Graduation from University of Hong Kong in 2004 with distinction in Medicine. He became a Specialist in Gastroenterology in 2012 in Hong Kong and awarded Fellow of Hong Kong College of Physician in 2012. Then, he further pursed his career on “Imaging enhanced endoscopy, endoscopic ultrasound, endoscopic submucosal dissection and submucosal tunnel dissection” in Japan under direct mentorship of Professor Takashi Toyonaga. He is now an honorary Clinical Assistant Professor at Chinese University of Hong Kong. He also published paper and invited speaker in various local and international journals, conferences and meetings.

Abstract:

Image enhanced endoscopy (IEE) is a combination of different advanced endoscopic methods which help to provide optical real time diagnosis for the luminal lesions. Traditional biopsy may have a disadvantage of sampling error since biopsy usually provide a small portion of lesion except the total excisional biopsy provided by small advanced excisional technique e.g, endoscopic submucosal dissection. Methods for IEE in general included special lighting e.g, narrow band imaging or blue laser imaging, both optical or digital magnification, chromoendoscopy and endoscopic ultrasound. Although different sites in luminal tract will have differences in terms of interpretion of IEE. In general, the purpose of IEE is to provide an optical diagnosis for a specific lesion regarding of the nature of lesion i.e., benign or malignant, and if the lesion is likely to have malignant component, the information about the depth of invasion can be provided. The approach of IEE start with the macroscopic appearance of the lesion in term of the color, shape, surface, consistency. The surface pattern and vascular pattern under the special light or chromoendoscopy are then observed to provide more information of the nature of the lesion and depth of invasion. Endoscopic ultrasound can provide more details of the depth of invasion. Good quality IEE is a must before any endoscopic treatment for the luminal lesion especially in the era of endoscopic submucosal dissection for good case selection.