South African Gastroenterology Review - latest Issue
Volume 14, Issue 2, 2016
Author Sandie ThomsonSource: South African Gastroenterology Review 14 (2016)More Less
As I edge ever closer to retirement one starts reflecting more and how one can continue to stimulate the youngsters into activity. I am pleased to say that a few up and coming starlets have put together an array of articles on an HPB theme and I am indebted to Ed Jonas for his help in editing their efforts. These are pretty sound relevant pieces for the trainees and more mature gastroenterologists alike. Dr Katsidzira reports back on his British Society of Gastroenterology adventure where he presented on aspects of his PhD to their sorority and fraternity. It is important that the fellows in training produce some worthwhile research for next years' award which will also include a weeks visit to a Gastroenterology Unit in the UK. My wish is that the next generation of South African gastroenterologists realize the value of researching African problems and finding solutions applicable to our health care environment and apply in numbers for our research awards.
Source: South African Gastroenterology Review 14, pp 7 –10 (2016)More Less
Mirizzi syndrome is a rare complication of longstanding gallstones disease causing extra hepatic bile duct obstruction by a stone in the cystic duct or Hartmann's pouch. Pablo Luis Mirizzi, an Argentinean surgeon's, main contribution to modern biliary surgery was the performance of first operative cholangiography in 1931. He published the syndrome synonymous with his name in 1948.
Author Eduard JonasSource: South African Gastroenterology Review 14 (2016)More Less
The focus of Devar's article in this issue is that advances in hepatobiliary imaging has decreased the role of and need for liver biopsy in the management of patients with liver tumours. The diagnostic accuracy of imaging equals and in most situations exceeds that of biopsy. Further development and refinement of functional imaging techniques, for example PET-CT, DWI-MRI, cell-specific contrast agents, MR spectroscopy and MR elastography will further enhance the accuracy of imaging-based characterization.
Source: South African Gastroenterology Review 14, pp 13 –17 (2016)More Less
Incidental liver lesions are being found more commonly due to advances in imaging modalities. Incidental focal liver lesions (FLLs) are found in up to 33% of radiological and 50% of autopsy studies. A lack of guidelines leaves non sub-specialist clinicians embracing all available modalities to establish a diagnosis, an approach which may result is costly suboptimal management. This review puts modern imaging in context and provides a practical algorithm to aid practice. The approach starts with a good clinical history and physical examination. In patients with known chronic liver disease one can anticipate primary hepatocellular carcinoma (HCC). In those with a family or personal history of prior malignancy or alarm symptoms suggestive of a gastrointestinal cancer metastatic disease is the most likely diagnosis. However in the healthy population group the differential diagnosis is wide and possibilities include both benign and malignant lesions. The former which often do not require resection and the latter which may require tailored oncotherapy with or without surgical resection.
Source: South African Gastroenterology Review 14, pp 19 –23 (2016)More Less
Pancreaticoduodectomy (PD) is considered one of the most complex procedures within general surgery and is performed for benign and malignant conditions of the pancreas and peri-ampullary region. Of the three anastomoses involved in reconstruction of the gastrointestinal tract after PD, namely gastro- orduodeno-enteric, bilio-enteric and pancreatico-enteric, the latter has the highest risk of failure and results in significant morbidity and mortality, principally due to septic and vascular complications. Distal pancreatectomy (DP) has historically been perceived as a less extensive and uncomplicated procedure, but today is recognized as having a similar risk profile as PD, predominantly due to post-resectional pancreatic leakage. The risk of death following pancreatic surgery is doubled in patients who develop a pancreatic leak or fistula.
Source: South African Gastroenterology Review 14, pp 25 –26 (2016)More Less
Sister Mary Joseph Dempsey (1856-1939) was the surgical assistant of William J. Mayo at St. Mary's Hospital in Rochester, Minnesota from 1890 to 1915. She had initially described the link between intra-abdominal malignancy and umbilical nodules, which Mayo later discussed in an article in 1928. In 1949 Sir Hamilton Bailey utilised the eponym of Sister Mary Joseph's Nodule, in his book "Physical Signs in Clinical Surgery" to describe umbilical metastases, in honour of Sister Mary.
Source: South African Gastroenterology Review 14, pp 29 –32 (2016)More Less
This guideline is intended as an educational tool to assist endoscopists treating patients with Barrett's oesophagus (BO). This is not intended as legal standard of care, nor is it meant to encourage, advocate or discourage any particular treatment. Final clinical decision on treatment of BO is a complex issue and remains the prerogative of the treating physician after full assessment of the patient's condition and prognosis with agreement of the patient on the chosen treatment modality.
Author Chris KassianidesSource: South African Gastroenterology Review 14, pp 35 –36 (2016)More Less
This year the Gastroenterology Foundation of South Africa celebrates its 10th anniversary. It is an appropriate time, therefore, to reflect on the achievements the Foundation has made over the past 10 years. It is an exciting time to be in South Africa and indeed in the whole of sub - Saharan Africa. Looming over the horizon and well within our reach lies the birth of the sub - Saharan Society of Gastroenterology and Hepatology. By all accounts the Foundation has been a success. How does one, however, measure the success of an educational trust such as the Gastroenterology Foundation of South Africa? Perhaps an audit of the number and quality of abstracts received at the annual SAGES congress might be an appropriate place to start. Our achievements however have been much broader than this. To begin with, the focus of the Foundation was on the continuing medical education of the practising gastroenterologist. It soon became apparent that this was not where our attention should be. An article in the South African Medical Journal in 2004, by Professor Sandie Thomson, highlighting the deteriorating state of academic gastroenterology in South Africa caught my eye. Mentorship is where we needed to start, and our attention quickly turned to the fellows in training.
Author Mirthe Van der ValkSource: South African Gastroenterology Review 14 (2016)More Less
Professor. Ronnie Fass, the director of the Division of Gastroenterology and Hepatology and Head of the Esophageal and Swallowing Center at the MetroHealth Medical Center, Cleveland Ohio visited Groote Schuur Hospital from 20 - 24 June, 2016. He is the "esophagologist" with special interest in functional oesophageal disorders, gastroesophageal reflux disease and oesophageal motility disorders. Prof Fass was invited by Prof Thomson to visit Groote Schuur Hospital and he sacrificed a whole week of his holiday to be with us. We had plenty of time to interact with him and he was able to give excellent talks "on demand". His visit kicked off with a talk on the new Rome IV classification. He made what has always been a hard topic to swallow for most trainees much more palatable. The major changes compared to the preceding Rome III classification for functional oesophageal disorders is the strong emphasis on excluding mechanical obstruction as a mechanism of symptom generation. For example, high resolution manometry for potential outflow obstruction should be performed and biopsies for eosinophilic esophagitis are essential. The second major change is the stricter criteria of GERD and the addition of 'reflux hypersensitivity' to the Rome IV classification. This incorporates patients with a positive symptom reflux correlation for physiological reflux.
Author Leolin KatsidziraSource: South African Gastroenterology Review 14 (2016)More Less
The British Society of Gastroenterology (BSG) annual meeting was held in Liverpool from 20-23 June 2016. I was fortunate enough to attend, having been the recipient of an inaugural BSG travel fellowship targeted at a South African based trainee. It was awarded after a competitive process which involved submitting an abstract followed by an oral presentation to the selection panel during the annual Spier meeting. The award covers all costs towards the BSG meeting, and you get the once in a lifetime (hopefully not!) opportunity to present your research at the event. It comes with the opportunity to publish your research in Frontline Gastroenterology; this is work in progress at the moment. This year's meeting was held in Liverpool, a historically important port city, home of the Beatles and home of a famous football club. The meeting was held during the British Isles summer, which was uncannily similar to the winter I had left in Cape Town. Only that in this instance it was called summer.
Author Daniel SurridgeSource: South African Gastroenterology Review 14 (2016)More Less
The Gastro Foundation hosted an IBD breakfast at the Inanda Club in Johannesburg on Saturday 9 July 2016. This is the first time that such a meeting has been held in Gauteng. It was hard to tear ourselves away from the sumptuous spread that had been laid on but the academic fare was even more delectable. Dr David Epstein from Cape Town first presented the updates to the IBD registry. The registry is going digital online at www.ibdafrica.org. The website will have portals for doctors, patients and medical aids. This will allow doctors to enter data about their patients and patients will be able to review data on their condition. Medical aids will finally have a portal for treatment recommendations and doctors can lobby for optimal treatment. Dr Epstein then followed up with 5 steps for success in managing IBD patients. This included when and how to initiate biologic therapy.
Author Sandie R. ThomsonSource: South African Gastroenterology Review 14 (2016)More Less
"Recently, I returned from Africa where I had the honor of attending the inauguration ceremonies of the two newest WGO Training Centers (TC), the Nairobi Training Center in Kenya and the Blantyre Training Center in Malawi. This experience left me meditating on the tagline of WGO, "Global Guardian of Digestive Health. Serving the World." These words are the backbone of everything we do at WGO. From our growing worldwide Training Center program, to the Train the Trainers workshop, to our Global Guidelines and Cascades, to our participation in some of the world's leading conferences on gastroenterology and related fields, and our member advocacy efforts through World Digestive Health Day, westrive to improve and serve the field of GI in the furthest reaches of the globe.