Gastroenterology July 26-26, 2021 London, UK

Biography:

Italian - brazilian, I have been physician since 2005. I am specializing in geral surgey, surgery of system digestive and endoscopy. Titular Member of Brazilian Society of digestive system surgery and Brazilian Society of digestive endoscopy. Member of ASGE. Partner Asociación Española de Gastroenterología (AEG). Master of Advanced Endoscopy in Barcelona-Spain, University of Barcelona and Hospital Clínic. Training in Endoscopic Ultrasonography and EUS-guided Fine Needle Aspiration by Barcelona-Spain, Clínic Hospital.

Abstract:

Exocrine pancreatic insufficiency (EPI) characterized by a deficiency of exocrine pancreatic enzymes, resulting in an inability to properly digest food or poor digestion. Clinical manifestations of EPI are often nonspecific and can lead to lack of timely recognition and diagnosis. The etiology of this deficiency includes both pancreatic and non-pancreatic causes. The condition is associated with significant morbidity and reduced quality of life, even in milder forms.

Challenges in managing this condition include the nonspecific presentation of mild-to-moderate EPI and the lack of an accurate and convenient diagnostic test.. Inadequate digestion and fat malabsorption occur when intraduodenal lipase levels fall below 5– 10% of normal production. Early pancreatic disease, evident steatorrhea does not occur until approximately 90% of gland function has been lost.

EPI manifestations are steatorrhea, malnutrition, deficiency of fat-soluble vitamins (A, E K, D) and trace elements, abdominal discomfort, bloating, weight loss and metabolic bone disease. Symptoms are non-specific and are shared with other common gastrointestinal conditions.

Many diagnostic tests are available to diagnose and have been classified as direct and indirect measures of exocrine pancreatic function. The gold standard has been 72-hour fecal fat test. The key of treatment is correctly use of PERT, stop smoking and alcohol consumption, consultation with a dietitian and a follow-up to ensure optimal treatment effect. A set of actions for normalize digestion, alleviate PEI symptoms and prevent malnutrition-related morbidity and mortality.
This review will summarize current concepts, diagnosis methods and treatment approaches using pancreatic enzymes for EPI.

Biography:

Dr Vignesh Balasubaramaniam, a 28 year old doctor, completed MBBS from Newcastle University and currently working in the department of General Surgery at Queen Elizabeth Hospital Kings’ Lynn.

 

Abstract:

Introduction:

Upper gastrointestinal bleed (UGIB) is a common presentation to the emergency department and accounts for approximately 50,000 - 70,000 admissions per year in the UK.Peptic ulcer disease (PUD) remains the most common cause of UGIB in the UK. Hemospray (Cook Medical, Winston-Salem, NC, USA) is an inert powder developed for endoscopic haemostasis. We aim to appraise the outcomes for UGIB where hemospray was used during the initial endoscopic therapeutic intervention.

Methods:

In this retrospective study from March 2018 to December 2020, cases of severe UGIB intervened with hemospray during primary presentation were identified via HICCS, an online database of endoscopy procedures. A detailed analysis of the demographics and outcome measures relating to the procedure, anatomical site of intervention, re-bleeding, and 30-day mortality were collected and interpreted. 

Results:

20 patients with severe UGIB were identified, where hemospray was used to control the bleeding when other modalities such as Adrenaline injection, Endoclip and Gold probe application failed to stop the bleeding. Among this population, the mean age was 73 years, ranging between 61 to 98 years. There were 14 male patients (70%) in this cohort. Majority of the therapeutic intervention site was at the duodenum (n = 14) accounting for 70 % of the patients, followed by stomach in 25 % (n = 5) and oesophagus (n = 1) in 5%. Causes for the severe UGIB were duodenal ulcer in 12(60%), gastric ulcer in 2(10%), gastric malignancy in 2(10%), Dieulafoy lesion in 1(5%), metastatic duodenal tumour in 1(5%), Angiodysplasia in 1(5%) and severe reflux oesophagitis in 1(5%). Hemospray was successful in achieving initial haemostasis in all cases except in one case of massive haemorrhage with poor view of the bleeding site in duodenum where the bleeding could not be stopped. Following initial hemostasis, re-bleed occurred in 4 out of 19 patients (21%) who were then managed with best supportive care as treatment escalation was not considered appropriate due to comorbidity. 7 patients (35%) died within 30 days of the procedure out of which four occurred due to re-bleed and three patients died due to other medical causes. 

Conclusions: 

In our experience, Hemospray has proven to be an effective therapeutic intervention in achieving haemostasis in cases of severe UGIB when other endoscopic therapies fail to stop bleeding.