Welcome Message from John Baillie

As the new editor of the WEO newsletter, I would like to welcome you to this issue. I am most grateful to WEO President, Dr Jerry Waye, for his kind invitation to take the helm of this exciting publication. I have been fortunate in my career as an academic gastroenterologist to contribute to many publications, from my own peer-reviewed articles in the endoscopy literature to textbooks, reviews, meeting syllabi, interactive, internet-based programs, etc. But my most rewarding experiences have been in editing for professional journals and newsletters. Helping colleagues get their hard-earned results published and into the mainstream endoscopy literature is both a privilege and a pleasure. I look forward

to using the WEO newsletter as a vehicle to highlight excellent work being done in our specialty from a wide range of sources, using a variety of media. For example, the current newsletter contains a wonderful review on H. Pylori by Dr Brennan Spiegel from the David Geffen School of Medicine at UCLA, Los Angeles, California. I thank Dr Spiegel for his contribution and encourage WEO newsletter readers to bring similarly outstanding works to my attention, so we can share them with a worldwide audience. We have all heard that "a journey of a thousand miles begins with a single step". Today, I take my first teetering steps as newsletter editor, but I am greatly looking forward to the journey!

 Journal Digestive Endoscopy

We are excited to announce that WEO has formed an official affiliation with the Journal Digestive Endoscopy (DEN). News from the World Organization of Endoscopy and portions of the WEO newsletter will from January 2012 be published in this prestigious journal. Videos from the WEO Centers of Excellence will be accessible from the Journal’s web site as well as from the WEO webpage.

“We are very pleased to have this bond of cooperation and look forward to a fruitful collaboration” Jerome Waye, WEO President says. “The field of endoscopy has rapidly changed in the last twenty years. Once the Ugly Duckling of medicine, the endoscope is now recognized as an indispensable tool for the diagnosis and treatment of a range of gastrointestinal diseases. Today’s world is getting faster and faster, and it is more important than ever for all medical professionals to keep on top of things. We feel that the cooperation with DEN will help endoscopists, surgeons, physicians, endoscopic nurses and technicians and other professionals with an interest in endoscopy to improve their knowledge and learn more about newest developments. Cheers to this alliance!”.

 WEO Outreach program

2011 has been a year of steady progress for the WEO Outreach Committee under the leadership of James A. DiSario.

Outreach projects across Latin America and Africa involve onsite activities with local donors of equipment, training and long term networking on various levels.

Geographically, the greatest emphasis in 2011 has been on Latin America with donations to units in Ecuador and Argentina. These two projects introduced a new era of the WEO Outreach Committee: Both sites are established, well functioning and cater insured patients or those who are able to pay. The WEO Outreach Committee has made highly sophisticated equipment available for these units and would like to thank Pentax as industrial partner for their support in this joint endeavour. It is the understanding of all involved that endoscopic services will now be offered to a significant number of financially disadvantaged or uninsured patients who previously would not have been treated adequately.

WEO will follow the progress of these units and hopes to continue this partnership with Pentax over the coming years.

 WEO Showcase: Centers of Excellence - Hong Kong, China

This month WEO highlights the endoscopy unit at the Prince of Wales Hospital in Hong Kong, China, one of the founding members of the WEO Centers of Excellence Group. The Prince of Wales Hospital is the teaching hospital of the Faculty of Medicine of The Chinese University of Hong Kong. They are responsible for nurturing healthcare professionals and spearheading medical research. So far, over 5,000 healthcare professionals have been trained. The hospital and the university work in close collaboration to provide patients with comprehensive service of the highest quality. Each year the Endoscopy Unit helps organize an international workshop on therapeutic endoscopy as well as several research projects under the auspices of WEO.

Live demonstration video

Dr Michael J Bourke, Director of Gastrointestinal Endoscopy, Westmead Hospital, Sydney, Australia demonstrates piecemeal resection of a laterally spreading tumor (LST) of the duodenal papilla at the July 2011 Hong Kong Endoscopy Workshop.

LSTs of the duodenal papilla represent some of the most challenging cases for the modern therapeutic endoscopist. Situated at the junction of the mid- and foregut, these lesions are highly vascular and located in a relatively thin part of the intestinal wall. As a result, the potential for therapeutic misadventure – especially bleeding and perforation - is high. Removing these lesions is a job for experts only! In this video, Dr Michael Bourke beautifully demonstrates the necessary careful, stepwise approach to debulking these tumors. First, the likely orifice of the bile duct is located: frequently this is a challenge, given the enormous distortion of the ampullary anatomy. The tumor is then resected stepwise using slow cooking by snare electrocautery. As Dr Bourke points out, it is essential for the endoscopist not to get greedy: trimming lumps of tumor too close to the duodenal wall invites perforation. Once the bulk of the tumor has been removed piecemeal, the bile duct is deeply cannulated and one or more stents are placed to ensure biliary drainage. At the end of the procedure, the resected tissue is recovered – usually by endoscopic netting – for histologic analysis.

» View live demonstration video

» Click here to view the WEO 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. This is the WEO 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 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: "Ectopic pancreas"

 Syllabus: H. pylori: Should We Still Be Looking for It? What Should We Be Doing    About It? A Case-Based Approach

Brennan Spiegel, MD, MSHS, FACG
2011 American College of Gastroenterology
Postgraduate Course

This article is abstracted from the 2011 American College of Gastroenterology Postgraduate Course, Washington, D.C.

It is now recognized that many ulcers in the upper GI tract are the result of an infection, and that stress (as important as it may be for generating some GI symptoms) does not cause ulcers. Since the discovery of H. pylori by Marshall and Warren , we have also learned that the pathogen is linked with many other ailments, including marginal T cell lymphoma (aka MALT), gastric adenocarcinoma, functional dyspepsia, gastroesophageal reflux disease (GERD), lymphocytic gastritis, Menentrier’s disease, dental caries, and iron deficiency anemia, among many others. It is noted that some of these links are proven and accepted (e.g. MALT), others are speculative or controversial (e.g. GERD, caries, iron deficiency).

At the present time the prevalence of H. pylori has fallen in much of the Western world, however it remains a very important pathogen that continues to generate a large worldwide burden of illness. There is no question that there is an ongoing need to test and treat for H. pylori in our patients but in light of evolving data on diagnosis and treatment of H. pylori, this review will focus in a case-based style the following: when we should test, how we should test, and how we should treat this highly prevalent pathogen.

This paper draws heavily from the American College of Gastroenterology management guidelines (see references), and focuses on salient clinical teaching points using up-to-date information on testing and treatment of H. pylori. Each vignette, below, presents a common clinical scenario, followed by a brief discussion of whether and how to test and treat H. pylori.

» Read more about H. pylori: Should We Still Be Looking for It? What Should We Be Doing About It?

 Brainteaser/image of the month

by Bjorn Rembacken

This was seen at the hepatic flexure after withdrawing the colonoscope from the caecum. The reason for the examination was chronic diarrhoea.

What is the most likely underlying diagnosis?

a) Irritable bowel syndrome

b) Microscopic colitis

c) Collagenous colitis

d) Crohn’s disease

e) Ulcerative colitis

» Click Here for the Answer and Explanation

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