South African Gastroenterology Review - latest Issue

As incoming president of SAGES it is with great pleasure I would like to welcome and thank all members that have been appointed onto SAGES Council. It is with immense pleasure I thank Prof Keith Newton who has served the council for a long time and his wisdom and patience will surely be missed.

Chronic kidney disease (CKD) after liver transplantation has become a frequently identified clinical entity. Despite progress in perioperative and postoperative management, many patients are left with CKD.

Endoscopy services in South Africa are in trouble. The two main problems are inadequate number of endoscopists and lack of endoscopy units. Endoscopy is a broad field and requires endoscopic professionals. As demands increase with a new wave of flexible endoscopy screening CRC programs, there is great need for expansion in the workforce to provide this diagnostic service . Equally, endoscopy still has to deal with more complex cases and therapeutic cases that will inevitably arise as a result of the increased diagnostic service. This requires extra (surgical) gastroenterologists who are prepared to take risks and accept the subsequent complications that will ensue. For endoscopy among nurses who are well trained there is interest to be trained for nurse endoscopist to deal with the shortage of enough endoscopists. Studies established that nurse endoscopists can safely perform colonoscopies and upper endoscopies. These are interesting, albeit challenging options for South Africa. In an era where safe, yet cost effective, policies run at the forefront of stakeholders’ minds, we discuss and suggest how nursing staff can undertake additional roles in the endoscopic suites and how to address this in the near future.

Autoimmune pancreatitis is a rare form of pancreatitis. It is characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis and often but not always, elevated serum IgG4 concentrations. The disease is recognised as a pancreatic manifestation of IgG4-related disease.

Kaposi sarcoma is a vascular tumour associated with human herpesvirus-8 infection (HHV-8). Four forms of this disease have been described. The classic variant of Kaposi sarcoma occurs predominantly in elderly men from Eastern Europe and Mediterranean countries. This form is not associated with Human Immunodeficiency virus/Acquired immunodeficiency syndrome (HIV/AIDS) infection but coincides with an altered immune system and with malignant diseases. Clinically, this variant is distinguished by multiple red to purple nodules on the lower limbs.

On Friday 1 November, 2100 delegates joined Prof Thomas Rösch, Professor Jürgen Pohl and Professor Thomas von Hahn in Hamburg to help deliver EndoClubNord, the largest live Endoscopy meeting in the World. The South African gastroenterology community and their nursing staff used for the third time the opportunity to join this live-streamed event from Hamburg.

The adopted 2016 plan to eliminate viral hepatitis globally is admirable and correct given the burden of, in particular, chronic hepatitis B and C infection. Within sub-Saharan Africa, hepatitis B is the dominant factor associated with chronic liver disease and especially hepatocellular carcinoma. Hepatitis B, identified in 1965, has had an effective vaccine available since 1981. Several countries adopted the vaccine early, but delays occurred is Africa. South Africa introduced the vaccine into the EPI schedule in 1995 and reduced, albeit not eliminated, hepatitis B prevalence has occurred. Similarly a few countries in Africa have developed viral hepatitis elimination plans but in most political will to develop and implement has lagged. One of the biggest challenges in fact, apart from political will, is awareness and stigma, 2 issues inversely proportional to each other. Stigma is high given low levels of awareness and education.

The Gastro Foundation sponsored Liver meetings embedded into SAGES have been successful. Starting in Durban, in 2015, where EASL partnered to start a series of “Best of EASL” meetings, these were very well received and have expanded into sub Saharan Africa. The foundation of the meetings are based on selected talks from the preceding EASL meeting postgraduate course.

Prof Radu Tutuian, Head Physician of Gastroenterology/Hepatology at Burgerspital Soluthurn in Switzerland, member of the European Society for Neurogastroenterology and Motility and acting president of the Swiss Neurogastroenterology and Motility Group, was an international speaker at the recent IAP ASSA SAGES congress held in Cape Town.

Dr Jay Hoofnagle, Director of the Liver Disease Research Branch in the Division of Digestive Diseases and Nutrition of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health (NIH) in Bethesda, Maryland, USA was the 2019 Solly Marks Visiting Professor. He visited the Groote Schuur Hospital/University of Cape Town Divisions of Gastroenterology and Hepatology from 12-19 August 2019

This trip was the 25th time that Prof. Paul Goldberg led a team to the Northern Cape. Originally the mission was to provide endoscopy support for the high–risk Lynch Syndrome family members who live there. In the quest to offer an internationally acceptable surveillance program for this group of patients, the team has grown significantly. As you can see from the group photo, 46 of us invaded the Northern Cape’s medical space.

A conversation with colleagues on South African healthcare tends to quickly turn on each of our experiences and concerns about the challenges and uncertainties attached to it. Yet, all over the country examples of individuals standing up to innovate, make a change and work towards a better future for all, are becoming evident. Friday the 27th of September 2019 was no exception as a team of people came together, some old, some new, to explore how we can move our country forward in terms of Patient Blood Management. The concept of saving blood (and resources), while saving patient lives, has inspired a team of people from a range of specialty areas, as far apart as health economics to obstetrics, surgery, critical care, obstetrics, blood service, haematology and anaesthesiology, to mention only a few examples, to sit down and realty think how to advance Patient Blood Management (PBM) in South Africa, and move it from a nice idea to a practical solution. What made the origins of the practice of PBM in South Africa special, is that it did not originate in the ivory towers of academia (where some of us do spend most of our waking hours), but in a township hospital in rural KwaZulu-Natal, where Dr Rob Wise initiated what came to be known as the “Saving Blood, Saving Lives Project”. Following in his footsteps and in that of the teams working on PBM around the world, we got together on this lovely Friday in September to discuss how to go about this.

Prizes and Scholarships awarded at SAGES 2019