Welcome to the World Endoscopy Organization

Welcome to the WEO newsletter. We have completed the name change from OMED to WEO but will keep both abbreviations (WEO/OMED) in our correspondence for another two months, after which time our organization will be known as the more easily recognized “WEO”, the World Endoscopy Organization.

Time is marching on at a rapid pace and this year will mark the halfway point for my four-year term as WEO/OMED President. We wish once again to let you know that officers of the WEO/OMED are elected by a popular vote of our 97 societies and are not handpicked by the board of governors or the WEO/OMED executive committee. The president changes every four years, and the next president is now the president-elect, Dr. William Chao, voted upon and installed by the Asian Pacific zone to which the presidency rotates on a regular basis, the past president of WEO/OMED is Dr. Anthony Axon from the European zone and I, of course, am from the American zone. All three zones are fully represented on the WEO/OMED executive committee to provide a unique total world outlook on endoscopy.

We have completely revamped the WEO/OMED website to make it easier to navigate and add new features. We appreciate the input of Dr. Roque Saenz from Chile, chairman of the WEO/OMED e-media committee. You can see all the archived videos on the website and learn when the Centers of Excellence across the world will hold their next live demonstrations.

Much information awaits you. Welcome to WEO.

» www.worldendo.org

 Affiliation with the Journal “Digestive Endoscopy”

We are pleased to announce that WEO has formed an official affiliation with the journal "Digestive Endoscopy" which is poised to become one of the leading endoscopic journals of the world. Many of our members subscribe to this journal along with the two other leading endoscopy journals: Gastrointestinal Endoscopy and Endoscopy. We encourage all readers to review this journal and subscribe to it since it will carry many of items of interest to WEO member societies and to individual endoscopists as well. Listed below are several points of interest which will be published in Digestive Endoscopy.

• WEO Centers of Excellence videos
• WEO guidelines
• WEO events, abstracts, supplements
• WEO images on an ongoing basis, this will be collated into a virtual issue

WEO is proud to become part of this successful publication and looks forward to a fruitful collaboration.

 ICE - International Congress of Endoscopy 2011, September 12 - 14, 2011

The International Congress of Endoscopy (ICE) 2011 is the unique event of the year. Organized by the 10 leading medical and surgical societies in the world, ICE provides a high quality program which will bring together the leaders in medical gastrointestinal endoscopy and surgical endoscopy including laparoscopy.

Renowned experts from all over the world will present and demonstrate in live sessions, the techniques of performing procedures and discuss the wide scope of surgical and medical endoscopic alternatives for management of varied gastrointestinal diseases.

Plan on attending ICE, the one-time event dedicated to celebrate the 50th Anniversary of Endoscopy!

Dates: September 12 - 14, 2011
Location: Los Angeles Convention Center, Los Angeles, CA, USA
Website: www.ice2011.org
Contact:ice2011@cpo-hanser.de

 WEO/OMED Showcase: Centers of Excellence

This month WEO/OMED highlights the Digestive Health Care Center at Massachusetts General Hospital in Boston, USA.

At the prestigious Digestive Health Care Center at Massachusetts General Hospital, teaching hospital for Harvard Medical School, more than 55 physician specialists and 65 nurses have created a successful patient-centered system. “Our collaboration is based on people with the same philosophy – to provide the best patient care possible,” explains William R. Brugge, M.D., Professor of Medicine, Harvard Medical School.

The third-oldest general hospital in the U.S. and the largest hospital in New England, Mass General is consistently ranked among the top five hospitals in the nation. Massachusetts General has had a GI unit for more than 100 years. “The most dramatic growth occurred in the last 15 years, when we went from 10 to 38 staff gastroenterologists,” Dr Brugge said. Originally the first to perform EUS, ERCP and bile duct endoscopy in the Boston area, these days the team performs approximately 2,000 advanced endoscopic procedures each year. The MGH GI group realized the potential for endoscopic pancreatic biopsies. “We began those in 1995 and the procedure has proven to be very successful.”

Live demonstration video

This is a 52 year old male who presents with LUQ pain after falling from a tree. An abdominal CT scan demonstrated a complex cystic lesion in the tail of the pancreas. Laboratory testing was unremarkable. The EUS exam demonstrated two pancreatic cystic lesions adjacent to a dilated splenic artery. During the EUS exam, there was concern that the cystic lesion involved the splenic artery and raised the possibility of a pseudoaneurysm. Fine needle aspiration revealed blood in one of the cysts. Aspiration from the other cyst revealed cells suggestive of a cystic neuroendocrine tumour. Eventually, a resection was performed and the histology was consistent with benign cystic neuro-endocrine tumour.

» View live demonstration video

» Click here to view the OMED Video library

 iPEN: Endoscopic terminology – MST at work (the iPEN initiative)

The standardization of endoscopic nomenclature is a vital element in the work to improve communication of endoscopic findings, between endoscopists, as well as to the referring physician. The Minimal Standard Terminology project was started to facilitate this process, and has recently gained momentum through the increased efforts by WEO/OMED. This is the WEO/OMED initiative for Proper Endoscopic Nomenclature (iPEN) which will encourage all endoscopists to use the same descriptive MST language to report their findings. The complete documentation of the terminology is available at the WEO website and the WEO/OMED Image atlas is being developed as a universally accessible source of high quality images. We will keep this issue in the minds of our readers by presenting endoscopic images regularly, along with the pertinent MST descriptive term, to remind endoscopists about the iPEN concept. For this, we would be delighted to have high quality images submitted to us for publishing in this series as well as inclusion into the online atlas. You send the photos, we will add the MST description.

Lars Aabakken, chairman,
Committee of standardization and terminology

Image of the month: "Peptic ulcer with visible vessel"

 The Management of Biliary Strictures

By Bret T. Petersen, MD, FASGE
Professor of Medicine
Mayo Clinic and College of Medicine
Rochester, Minnesota

This article is excerpted from a syllabus contribution of Dr. B. Petersen presented at the last meeting of the ASGE Annual Course in New Orleans at the time of DDW 2010.

Biliary strictures occur as a result of multiple etiologies and with widely varied presentations. Important elements in the assessment and management of biliary strictures include:

• Stricture characterization: length, width, location, assessment of malignancy
• Endoscopic stricture access, with dilation and stent placement for unresectable malignant lesions and most benign lesions
• Medical management for specific inflammatory lesions,
• Surgical management for resectable malignant lesions and selected benign lesions

Stricture characterization employs stepwise assessment of the history, laboratory studies, and imaging results. Non-invasive cross-sectional imaging is accomplished with ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), typically with magnetic resonance cholangiopancreatography (MRCP). Invasive imaging includes endoscopic ultrasonography (EUS) for diagnosis and tissue acquisition and endoscopic retrograde cholangiopancreatography (ERCP) for tissue sampling and palliative or definitive stenting.

» Read more

 Brainteaser/image of the month

by Bjorn Rembacken

This gastric ulcer was found in a 57 year old man undergoing gastroscopy for dyspeptic symptoms. A proton pump inhibitor was prescribed and the gastroscopy was repeated one month later. The photographs have been taken before and after one months of therapy. A rapid urea test for Helicobacter pylori is positive. A couple of biopsies were taken from the edge of the lesion but were reported as inconclusive as the histopathologists were unable to agree if this was dysplastic mucosa or simply a reactive, inflamed epithelium.

What is the most likely diagnosis?

a) gastric erosion

b) benign peptic ulcer

c) early gastric cancer

d) gastric lymphoma

e) CMV gastritis

» Click Here for the Answer and Explanation

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