HealthWestern SydneyLocal Health District

TOPICS INCLUDE

Paul Fockens – Amsterdam

Doug Rex – Indianapolis

Michael Wallace – Jacksonville

Pinghong Zhou – Shanghai

INTERNATIONAL FACULTY

Luke Hourigan

Fin Macrae

AUSTRALIAN FACULTY

• Colonoscopy

– Optimising insertion

– Best practice withdrawal and adenoma detection

– Enhanced imaging modalities/Optical diagnosis

– New techniques and technology

• Barrett’s Oesophagus

– Detection of inconspicuous neoplasia and dysplasia

– Approach to endoscopic therapy

• Endoscopic stenting for benign and malignant disease

• Endoscopic treatment of perforations and fistulas

• Endoscopic ultrasound

• ERCP: complex and basic therapeutics

• Direct cholangioscopy

• Balloon and capsule enteroscopy

• Novel endoscopic haemostatic therapies

Sydney International Endoscopy Symposium

Thursday 6th & Friday 7th March, 2014

Hilton Sydney, AustraliaIncorporating the Westmead Endoscopy Symposium Nurses’ Workshop – Wednesday 5th March, 2014

Thursday 6th & Friday 7th March

2014

CONFERENCE PROGRAM AND SYLLABUS

7th WWW.SIES.ORG.AU

2

Please review Product Information before prescribing. To have a copy of the Product Information sent to you, telephone AbbVie Medical Information on: 1800 043 460.

MINIMUM PRODUCT INFORMATION: HUMIRA (adalimumab). INDICATIONS: Crohn’s Disease (CD): Treatment of moderate to severe CD in adults to reduce the signs and symptoms of the disease and to induce and maintain clinical remission in patients who have had an inadequate response to conventional therapies, or who have lost response to or are intolerant of infliximab. Ulcerative colitis (UC): Treatment of moderate to severe ulcerative colitis in adult patients who have had an inadequate response to conventional therapy or who are intolerant to or have medical contraindications for such therapies. Patients should show a clinical response within 8 weeks of treatment to continue treatment beyond that time (see CLINICAL TRIALS). CONTRAINDICATIONS: Severe infections including sepsis, active TB, opportunistic; concurrent anakinra; moderate to severe heart failure. PRECAUTIONS: Infections (bacterial, mycobacterial, invasive fungal e.g, histoplasmosis, viral or other opportunistic); hepatitis B, latent TB; demyelinating disorders; haematologic events; live vaccines; immunosuppression; new or worsening CHF; renal, hepatic impairment; malignancy; hypersensitivity reactions; latex sensitivity; concurrent abatacept; elderly; pregnancy, lactation, surgery. ADVERSE REACTIONS: Respiratory tract infections, leucopaenia, anaemia, headache, abdominal pain, nausea and vomiting, elevated liver enzymes, rash, musculoskeletal pain, injection site reaction are very commonly seen adverse events. Benign neoplasm and skin cancer including basal cell and squamous cell carcinoma were commonly reported. Fatal infections such as tuberculosis and invasive opportunistic infections have rarely been reported. For others, see full PI. DOSAGE & METHOD OF USE: CD and UC: Induction: 160mg sc (Four injections on Day 0 or Two injections on Day 0 and 1), 80mg as two sc injections on Day 14, then Maintenance: 40mg sc starting on Day 28 and continuing fortnightly. DATE OF PREPARATION: November 2013, based on Product Information last updated November 2013, Version 19a ®Registered trademark of AbbVie Pty Ltd. ABN 48 156 384 262. 32-34 Lord Street, Botany NSW 2019. Ph: 1800 043 460. AU-HUMG-2013-12c, Feb, 2014 *George, HUMIRA-treated patient March 2013.

PBS Information: Authority required for the treatment of adults with severe refractory Crohn’s disease and complex refractory fistulising Crohn’s disease. Refer to PBS Schedule for full authority information and additional indications.

This product is not listed on the PBS for the treatment of ulcerative colitis.

3

Please review Product Information before prescribing. To have a copy of the Product Information sent to you, telephone AbbVie Medical Information on: 1800 043 460.

MINIMUM PRODUCT INFORMATION: HUMIRA (adalimumab). INDICATIONS: Crohn’s Disease (CD): Treatment of moderate to severe CD in adults to reduce the signs and symptoms of the disease and to induce and maintain clinical remission in patients who have had an inadequate response to conventional therapies, or who have lost response to or are intolerant of infliximab. Ulcerative colitis (UC): Treatment of moderate to severe ulcerative colitis in adult patients who have had an inadequate response to conventional therapy or who are intolerant to or have medical contraindications for such therapies. Patients should show a clinical response within 8 weeks of treatment to continue treatment beyond that time (see CLINICAL TRIALS). CONTRAINDICATIONS: Severe infections including sepsis, active TB, opportunistic; concurrent anakinra; moderate to severe heart failure. PRECAUTIONS: Infections (bacterial, mycobacterial, invasive fungal e.g, histoplasmosis, viral or other opportunistic); hepatitis B, latent TB; demyelinating disorders; haematologic events; live vaccines; immunosuppression; new or worsening CHF; renal, hepatic impairment; malignancy; hypersensitivity reactions; latex sensitivity; concurrent abatacept; elderly; pregnancy, lactation, surgery. ADVERSE REACTIONS: Respiratory tract infections, leucopaenia, anaemia, headache, abdominal pain, nausea and vomiting, elevated liver enzymes, rash, musculoskeletal pain, injection site reaction are very commonly seen adverse events. Benign neoplasm and skin cancer including basal cell and squamous cell carcinoma were commonly reported. Fatal infections such as tuberculosis and invasive opportunistic infections have rarely been reported. For others, see full PI. DOSAGE & METHOD OF USE: CD and UC: Induction: 160mg sc (Four injections on Day 0 or Two injections on Day 0 and 1), 80mg as two sc injections on Day 14, then Maintenance: 40mg sc starting on Day 28 and continuing fortnightly. DATE OF PREPARATION: November 2013, based on Product Information last updated November 2013, Version 19a ®Registered trademark of AbbVie Pty Ltd. ABN 48 156 384 262. 32-34 Lord Street, Botany NSW 2019. Ph: 1800 043 460. AU-HUMG-2013-12c, Feb, 2014 *George, HUMIRA-treated patient March 2013.

PBS Information: Authority required for the treatment of adults with severe refractory Crohn’s disease and complex refractory fistulising Crohn’s disease. Refer to PBS Schedule for full authority information and additional indications.

This product is not listed on the PBS for the treatment of ulcerative colitis.

WELCOME!Dear Colleagues and Friends,

It is my great pleasure to welcome you to the Sydney International Endoscopy Symposium, our 7th Annual Westmead Endoscopy meeting. Once again we have set ourselves the goal of a comprehensive demonstration of diagnostic and therapeutic endoscopy. I believe that this year will be our most successful event yet.

We are delighted to welcome four truly outstanding clinicians from abroad; Paul Fockens, Doug Rex, Mike Wallace and Pinghong Zhou, as our expert faculty. All of them are leaders on the international stage having made numerous outstanding contributions to the practice of Endoscopy over the last ten to twenty years. Their insights are eagerly awaited.

The Symposium’s content has been carefully designed to facilitate discussion. Please utilise the new SIES2014 App or Twitter via your mobile phone to relay your questions through the chairs to our proceduralists. This is a new and unique feature that will enhance the interaction between the expert faculty and the audience. A strong emphasis on the cognitive processes behind the delivery of high quality endoscopy will feature. Several novel technologies will also be demonstrated.

On behalf of our Department, Nurses and Doctors alike, I thank you for your support and for interrupting your busy schedules to join us here for these two special days. I believe the international guests, in combination with our Australian faculty and the team from Westmead, will provide an enlightening and informative educational experience for you, and hopefully a very enjoyable one.

Yours sincerely

Michael Bourke Chairman Sydney International Endoscopy Symposium 2014 Director of Gastrointestinal Endoscopy, Westmead Hospital

WELCOME TO NURSES

It is a great pleasure to welcome you to the 7th Sydney International Endoscopy Symposium Nurses’ Workshop. The Westmead Endoscopy team has prepared another fabulous and stimulating array of talks and demonstrations which will enhance your understanding of Gastrointestinal Endoscopy.

We are delighted to have a large and diverse group of fabulous speakers on our programme including Farzan Bahin, David van der Poorten, Vu Kwan, Sandra Ko, Michael Bourke and our 2012 international speaker Maria Cirocco.

We have continued with the very popular demonstration stations this year and you will have hands-on opportunities with the latest devices in therapeutic endoscopy.

The Symposium is also an avenue for networking and interaction amongst the great nursing minds in Endoscopy, offering updates and learning fresh tips and tricks to promote gastrointestinal endoscopy nursing.

Nurses are encouraged to attend the two full days live high quality transmission from the Westmead Endoscopy Suite to the Hilton Sydney Hotel which will showcase the latest development with interesting and challenging cases that demonstrate the skills and wisdom of the internationally renowned guest faculty.

RCNA points will be available for nurses attending the Symposium.

Yours sincerely

Mary Bong Nurse Unit Manager Endoscopy Unit Westmead Hospital Organising Committee Sydney International Endoscopy Symposium Nurses’ Workshop 2014

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PROF PAUL FOCKENSProfessor and chair of Gastroenterology and Hepatology at the Academic Medical Centre, University of Amsterdam

Professor Paul Fockens is Professor and chair of Gastroenterology and Hepatology at the Academic Medical Centre at the University of Amsterdam.

He is the current president-elect of the European Society of Gastrointestinal Endoscopy and chairman of the EURO-NOTES foundation. His clinical and research interests are advance diagnostic and therapeutic endoscopy. He focusses on colorectal cancer and pancreato-biliary imaging and therapy. The research is clinical as well as more fundamental with very regular use of the anomal facility for acute and survival studies. In his capacity as chairman of the European Postgraduate Gastro-Surgical School, he organises an annual EUS course since 17 years (next EUS-course June 5 & 6 2014) as well as Amsterdam Live Endoscopy, an annual course attracting 500+ participants each year since 7 years.

PROF MICHAEL WALLACEProfessor of Medicine, Mayo Clinic, Jacksonville

Prof Wallace received his medical degree from Duke University School of Medicine in 1992. He completed a residency program in Internal Medicine in 1995 and a fellowship in Gastroenterology and Hepatology in 1998 at the

Brigham and Women’s Hospital in Boston, Massachusetts. During that time, he also completed a Master’s in Public Health with a focus on clinical research at the Harvard School of Public Health.

Prof Wallace completed an advanced endoscopy fellowship in Endoscopic Ultrasound (EUS) and Therapeutic Endoscopic Retrograde Cholangiopancreatography (ERCP) in 1999 at the Medical University of South Carolina.

He remained on faculty at MUSC until 2003, when he joined the Mayo Clinic as associate Professor and director of Gastroenterology Research. He was promoted to Professor in 2007. Prof Wallace served as Chair of the Research Committee for the American Society for Gastrointestinal Endoscopy from 2008-2011. Since 2010, he has served as Chief of Gastroenterology and Hepatology at Mayo Clinic Florida.

Prof Wallace’s research focuses on advanced endoscopic imaging technologies including light scattering spectroscopy, autofluorescence imaging, narrow band imaging, confocal endomicroscopy and molecular imaging as they pertain to early neoplasia of the gastrointestinal tract.

Prof Wallace was principal investigator in an NIDDK-funded trial of EUS Neurolysis in pancreas cancer. He was also principal investigator in a National Cancer Institute-funded trial evaluating the role of EUS in lung cancer staging.

Prof Wallace has published more than 200 peer reviewed manuscripts and more than 200 abstracts, book chapters, review articles and editorials. In addition, he has mentored more than 20 Advanced Endoscopy fellows from around the world.

PROF DOUG REXProfessor of Medicine and Director of Endoscopy in the Division of Gastroenterology & Hepatology, Indiana University Medical Center, IndianapolisProf Doug Rex is Distinguished Professor of Medicine at Indiana University School of Medicine, Chancellor’s Professor at Indiana

University Purdue University Indianapolis, and Director of Endoscopy at Indiana University Hospital in Indianapolis. He graduated from Harvard College, Summa Cum Laude in 1976 and with highest distinction from Indiana University School of Medicine in 1980. He served as Chief Medical Resident at Indiana University Hospital and joined the faculty at Indiana University in 1985. He received the Outstanding Teacher Award in the Introduction to Medicine course five times and has been awarded the Indiana University School of Medicine Outstanding Teacher Award as well as Department of Medicine’s Excellence in Teaching Award. He is a full-time clinical gastroenterologist at Indiana University Hospital.His major research interests have been in colorectal disease and, in particular, colorectal cancer screening and the technical performance of colonoscopy. He co-authored the colorectal cancer screening recommendations of the American College of Gastroenterology and the US Multi-Society Task Force on Colorectal Cancer. He also authored the recommendations on quality in colonoscopy of the US Multi-Society Task Force on Colorectal Cancer and the American College of Gastroenterology/American Society of Gastrointestinal Endoscopy.

PROF PINGHONG ZHOUGeneral Surgeon, Zhongshan Hospital, Fudan University, ShanghaiProf Pinghong Zhou is currently a specialist in therapeutic endoscopy, as well as a general surgeon of Zhongshan Hospital, Fudan University, Shanghai, China. Prof Zhou graduated from Shanghai Medical University

in 1992, and obtained his doctorate degree from Fudan University in 2003.Having completed his basic surgical training in the department of general surgery of Zhongshan Hospital from 1992 to 1998, he started his training in digestive endoscopy as a senior resident in 1999. He also received the most comprehensive training in various areas of advanced endoscopy, such as EUS under the mentorship of Kenjiro Yasuda in Kyoto Second Red Cross Hospital of Japan in 2000, ESD under Hiroyuki Ono in Shizuoka Cancer Center of Japan in 2006, ERCP under Peter B Cotton in the Medical University of South Carolina, USA in 2008.His main research focuses on endoscopic diagnosis and treatment of gastrointestinal tumor. He is one of ESD pioneers in China and has gained much experience in EMR, EPMR and ESD. Recently he is very interested in endoscopic resection of submucosal tumor (SMT) and tunnel endoscopic surgery, such as peroral endoscopic myotomy (POEM) of esophageal achalasia.

INTERNATIONAL FACULTY

The attendance of the international faculty has been graciously supported by our Platinum Sponsors

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ADVANCING THEART OF ENDOSCOPY

www.olympusaustralia.com.au

6www.cookmedical.com

HEMOS TA SIS

© COOK 2014 ESC-WAPACADV-INSTINCT-GIE-201402

Instinct™

E N D O S C O P I C H E M O C L I P

Trust your instincts.Don’t chain yourself to clips and delivery systems that are counterintuitive and difficult to control. Open your mind to the exciting new option for endoscopic clipping that gives you intuitive control of the widest opening span on the market.

It’s time to follow your instincts and leave the past behind.

Images courtesy of Dr. Mario Traina Ismett Hospital, Palermo, Italy.

ESC-WAPACADV-INSTINCT-EN-201402.indd 1 2/10/14 9:05 AM

NURSES’ WORKSHOP - WEDNESDAY 5TH MARCH 2014

0730 REGISTRATION OPENS

0830 - 0845 Welcome Note – Mary Bong RN and Joanne Edwards DON Westmead Hospital

SECTION 1 - Facilitator: Robyn Brown

0845 - 0910 Managing polypectomy complications: bleeding, perforation and others - Prof Michael Bourke

0915 - 0940 Barrett’s: What’s the fuss about diagnosis and treatment in 2014? - Dr Farzan Bahin

0945 - 1010 The importance of nursing admission and assessment in the Day Surgery setting - Sandra Ko RN

1015 - 1040 Infection control: Where to now? - Maria Cirocco

1045 - 1115 Morning Tea and Trade Displays

SECTION 2 – Workshop Demonstrations & Presentations - Facilitator: Mary Bong

1115 - 1330

DEMONSTRATION 1Tools for managing polypectomy complicationsCo-ordinator - Robyn Brown

DEMONSTRATION 2Principles, safe and effective use of endoscopic devices Co-ordinator - Jenevieh Junio

DEMONSTRATION TALK 3What’s new in 2014 Co-ordinator - Janice Waru

BOOTH 1Deployment of clipsNicky Stojanovic and Co. Reps

BOOTH 1ERCP Stone retrieval and crushingsJudy Tighe-Foster and Co. Rep

TALK 1Principles of intraductal stone crushersAmelia Tighe

BOOTH 2Coagulation devices Rebecca Sonson & Polly Leong

BOOTH 2EUS FNA needle techniquesSandra Ko

TALK 2EUS images interpretations Vu Kwan

BOOTH 3RecipesMariam Khilwati Ovesco ClipsStephanie Henshaw and Co. Rep

BOOTH 3Barrett’s TherapyHelna Lindhout and Vanessa McArdle-Gorman

TALK 3Interpretation of GI Radiological imagesDr Farzan Bahin

BOOTH 4Snares and Diathermy settings Zion Siu and Co. Rep

BOOTH 4Achalasia DilatationBetty Lo and Alison Bannister

TALK 4Highlighting biofilms in endoscope reprocessingGreg Whiteley

1330 - 1430 Lunch and Trade Displays

SECTION 3 - Facilitator: Judy Tighe-Foster

1430 - 1445 Quiz - Zion Siu RN

1445 - 1510“Trap that polyp” How and Why? - Maria Cirocco

What happens when it goes to the lab? - Dr Farzan Bahin

1515 - 1540 Hard to swallow (Achalasia) - Dr David van der Poorten

1545 -1600 Open forum: Question time – Di Jones and Debbie McQueen

1600 - 1615 Quiz prizes, presentations and surprises

1615 - 1620 Closing remarks and thank you

1630 Afternoon Tea and Trade Displays

77

Kindly supported by

NURSES’ WORKSHOP PROGRAM

SYDNEY INTERNATIONAL ENDOSCOPY SYMPOSIUM 2014 NURSES’ WORKSHOPThis workshop is endorsed by APEC number 014011002 as authorised by Australian College of Nursing (ACN) according to approved criteria. Attendance attracts 6 ACN CNE points as part of ACN’s Life Long Learning Program (3LP).

“Reference herein to any specific commercial products, process, or service by trade name, trademark, manufacturer or otherwise, does not necessarily constitute or imply its endorsement, recommendation, or favouring by ACN”

www.cookmedical.com

HEMOS TA SIS

© COOK 2014 ESC-WAPACADV-INSTINCT-GIE-201402

Instinct™

E N D O S C O P I C H E M O C L I P

Trust your instincts.Don’t chain yourself to clips and delivery systems that are counterintuitive and difficult to control. Open your mind to the exciting new option for endoscopic clipping that gives you intuitive control of the widest opening span on the market.

It’s time to follow your instincts and leave the past behind.

Images courtesy of Dr. Mario Traina Ismett Hospital, Palermo, Italy.

ESC-WAPACADV-INSTINCT-EN-201402.indd 1 2/10/14 9:05 AM

The attendance of Maria Cirocco has been graciously supported by

DAY ONE – THURSDAY 6TH MARCH 2014

0730 REGISTRATION OPENS

0830 - 0835 Official Conference Open and Welcome – Michael Bourke, Shaun Drummond

MINI SYMPOSIUM: OPTIMISING COLONIC POLYPECTOMY

0835 - 0855 Getting the most out of imaging – Michael Wallace

0855 - 0915 Ensuring that the polyp is completely removed – Doug Rex

0915 - 1030 LIVE ENDOSCOPY 1. Chairs: David van der Poorten, Raj Singh, Maria Pellise

1030 - 1100 Morning Tea

1100 - 1300 LIVE ENDOSCOPY 2. Chairs: Michael Swan, Nghi Phung, Arthur Kaffes

1300 - 1400 Lunch

1400 - 1530 LIVE ENDOSCOPY 3. Chairs: Vu Kwan, Sina Alexander, Rick Hope

1530 - 1600 Afternoon Tea

1600 - 1625 Pancreatic cancer screening: who and how? – Paul Fockens

1625 - 1635 DISCUSSION

1635 - 1700 General Endoscopy Quiz – Nick Tutticci

1700 CLOSE

1700 - 1800EXPERTS ON THE SPOT: MINI-SYMPOSIUM The interface between IBD and Endoscopy Chaired by Luke Hourigan: Panellists - Fin Macrae, Doug Rex, Michael Wallace, Maria Pellise

1830 - 1845 Coaches depart promptly for Symposium Reception

1845 - 2045 OFFICIAL SYMPOSIUM RECEPTION – Sydney Opera House ‘Opera Point Marquee’

*Coaches will depart the Hilton Sydney Hotel from 6.30pm sharp (one-way transfer), alternatively, you can make your own way to the venue, allow approximately 20 minutes from the Hilton Sydney Hotel.

SYMPOSIUM PROGRAM

Thursday 6th March 6.45pm – 8.45pm

SYMPOSIUM RECEPTION at Sydney Opera House ‘Opera Point Marquee’

Enjoy drinks and canapés on the picturesque Sydney Harbour foreshore! The Opera Point Marquee offers a magnificent vantage point to enjoy one of the world’s most famous views. The venue makes the most of this setting with a private outdoor reception area and clear walls which will ensure you enjoy the vista from every angle.

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DAY TWO – FRIDAY 7TH MARCH 2014

0730 REGISTRATION OPENS

0830 - 0900 Rethinking Endoscopic complications: Definition, recognition and management in 2014 – Paul Fockens

0900 - 1030 LIVE ENDOSCOPY 4. Chairs: Stephen Williams, Rita Lin, Alan Moss

1030 - 1100 Morning Tea

1100 - 1300 LIVE ENDOSCOPY 5. Chairs: Golo Ahlenstiel, David Ruppin, David Hewett

1300 - 1400 Lunch

1400 - 1530 LIVE ENDOSCOPY 6. Chairs: Eric Lee, Gregor Brown, Thao Lam

1530 - 1600 Afternoon Tea

1600 - 1630 The Peter Gillespie Lecture – Colorectal Cancer – Screening and Prevention: now and in the future - Doug Rex

1630 - 1645 Quiz Answers and Awards for the Winners – Nick Tutticci

1645 - 1700 CLOSING REMARKS

SYMPOSIUM PROGRAM

Mark your diary NOW, next year’s Symposium dates!

Wednesday 4th - Friday 6th March, 2015

MARCH 2015TM SFTS W

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15 1817 212016 19

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22 25 24 282723 26

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Each delegate will receive a stylish satchel bag, courtesy of Cook Medical – available for collection when registering.

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ENDOTHERAPY

• The NEW Pentax MagniView Endoscope • 4 Optical Zoom Levels • Up to a 136 x magnified image • HD+ image technology • i-Scan compatible for detection and clarification options

ENDOSCOPES

The MagniView endoscope

P: 1800 429 551 | E: customers@device.com.au | device.com.au

™

• Complete range of cleaning and reprocessing products available

• Revital-Ox: NEW range of pre-cleaning, cleaning and high level disinfection products

• AERs: STERIS® Reliance™ EPS and STERIS® System 1™ Express

REPROCESSORS

YOUR COMPLETE ENDOSCOPY SOLUTION

Reliance™ EPS

COME VISIT US AT BOOTH 8

• NEW Medwork® range of ERCP and Endoscopy consumables

• US Endoscopy range of Endoscopy consumables

• CapsoCam Capsule Endoscope

NEW

Pioneering Possibility

ABSTRACTSENDOTHERAPY

• The NEW Pentax MagniView Endoscope • 4 Optical Zoom Levels • Up to a 136 x magnified image • HD+ image technology • i-Scan compatible for detection and clarification options

ENDOSCOPES

The MagniView endoscope

P: 1800 429 551 | E: customers@device.com.au | device.com.au

™

• Complete range of cleaning and reprocessing products available

• Revital-Ox: NEW range of pre-cleaning, cleaning and high level disinfection products

• AERs: STERIS® Reliance™ EPS and STERIS® System 1™ Express

REPROCESSORS

YOUR COMPLETE ENDOSCOPY SOLUTION

Reliance™ EPS

COME VISIT US AT BOOTH 8

• NEW Medwork® range of ERCP and Endoscopy consumables

• US Endoscopy range of Endoscopy consumables

• CapsoCam Capsule Endoscope

NEW

Pioneering Possibility

11

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ABSTRACTS

Getting the most out of imagingMICHAEL WALLACE

Recent advances in endoscopic imaging have significantly improved our ability to detect, classify, and completely remove nearly all early colorectal neoplasia. Major advances in our ability to detect polyps include the simple awareness that flat neoplasia exists in Western populations and educational programs to train endoscopist in their appearance. Other major technical advances include the use of chromoendoscopy, high-definition colonoscopy, and imaging enhanced endoscopy such as NBI, FICE and, iScan.

Once colonic neoplasia is detected it is increasingly important to classify polyps which need not be removed such as small distal hyperplastic polyps, polyps which can be removed with routine polypectomy methods such as low-grade adenomas, polyps which need advanced resection method such as endoscopic mucosal resection and ESD, and lastly polyps which require surgical resection such as those with deep invasion. The major methods to achieve this are high-definition endoscopes, chromoendoscopy with our without zoom, NBI, FICE and iScan. The shape of the lesion, typically described by the Paris classification, also allows for proper selection of removal methods

In summary we now had the capabilities to detect and endoscopically remove virtually all early neoplastic lesions in the colon.

Ensuring that the polyp is completely removedDOUG REX

The discussion about effectiveness of polyp removal is best based on polypectomy technique. In general, predictors of ineffective polypectomy are increasing polyp size, polyps of any size in the serrated class, and the use of a piecemeal rather than en bloc approach.

Available evidence indicates that hot forceps are an ineffective approach to polypectomy, and should be abandoned. In 2 studies of polyps removed with hot forceps and tattooed, followup showed incomplete resection in 16 and 28%.

Randomized control trials showed that jumbo forceps are more effective than large capacity forceps in completely removing tiny polyps. In addition, there is evidence that piecemealing diminutive polyps with cold forceps results in a lower eradication rate. In a randomized trial comparing cold biopsy to cold snaring, cold snaring became more effective at a polyp size of 4 mm or larger (the study included only polyps < 5 mm). A reasonable approach in my opinion is to consider cold forceps when a polyp is in a difficult location in the endoscopic field (e.g. upper left) and it is sufficiently small that it can be engulfed in a single bite.

A recent randomized control trial has suggested that for polyps up to 9 mm in size, cold snaring is as effective as hot snaring. Optimal technique with cold snaring involves capturing a rim of normal mucosa around the polyp. This is facilitated by forcefully anchoring the tip of the snare sheath one to several millimeters away from the polyp.

In my opinion, hot snaring without injection still has an important role for a number of polyps in the 5 to 20 mm size range. Polyps in this size range can be safely and efficiently removed without injection. Particularly in the case of serrated lesions, grabbing 1 to 3 mm of normal tissue around the polyp can be appropriate to reduce the risk of leaving residual polyp.

For larger polyps removed by endoscopic mucosal resection, important steps include effective injection technique using a large mound of hydroxyethyl starch. The use of a contrast agent helps to track the edges of the lesion, particularly for serrated lesions. In the case of piecemeal resection, the contrast also facilitates identification of residual portions of the polyp. In the case of serrated lesions, these residual portions can be identified by the variation in the pit pattern from normal. In general, the pits on serrated lesions tend to be larger, darker, and the surface has a clearly different texture then normal mucosa. High definition is essential to this process. Finally, snare resection is preferable to ablation for all elements of the polyp. However, for portions that cannot be effectively snare resected, ablation using the snare tip in the soft coag mode, or ablation with the argon plasma coagulator, reduces the risk of residual polyp at first followup.

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ABSTRACTS

Colorectal cancer screening and prevention now and in the futureDOUG REX

Preferred methods of colorectal cancer screening and the extent of adherence to colorectal cancer screening recommendations varies widely by nations. Resources available for colonoscopy and willingness to spend on colonoscopy screening have a major effect on the approach taken. Within the United States, there is rising interest in the use of fecal immunochemical testing (FIT) as a primary approach, with reservation of colonoscopy screening for high risk patients. However, the use of colonoscopy is still widely reimbursed and heavily utilized by doctors for average-risk persons. All guidelines now recommend the use of FIT over guaiac testing. Recent meta- analyses suggest that the commercially available FITs are comparable with regard to performance, but the assays developed by Eiken Chemical and marketed in the United States by Polymedco under the OC brand have by far the largest body of accumulated evidence. These assays are available for both point of care qualitative office screening and for population-based screening using a laboratory based commercial assay. The specificity of FIT testing is very high, typically at least 95% and the program sensitivity has been estimated to be potentially as high as colonoscopy screening at 10-year intervals. Several randomized controlled trials comparing FIT to colonoscopy are currently underway.

There are no available data on the sensitivity of FIT for serrated lesions. Serrated lesions may be the precursors of up to 30% of colorectal cancer. Endoscopically, they have few or no blood vessels on the surface, and thus they may not bleed to be easily detected by FIT. Colonoscopy sensitivity for serrated lesions is highly variable, and the variability exceeds that of colonoscopy sensitivity for conventional adenomas.

Fecal DNA testing became available in the United States in 2003 and has received almost no use. The US Preventive Services Task Force declined to recommend fecal DNA testing, though it was recommended by the US Multisociety Task Force and American Cancer Society for patients who declined cancer prevention tests (imaging tests) as an alternative to FIT. An interval was not specified in that guideline. The American College of Gastroenterology recommends colonoscopy as the preferred screening strategy, and FIT as the preferred test in patients who decline colonoscopy, but recommended fecal DNA testing every 3 years as an alternative. Interest in fecal DNA testing has increased because of progressive improvements in the technology. The most recent “deep-C” study found high sensitivity for cancer and for polyps greater than 1 cm of 40%. Sensitivity increases with increasing polyp size. The specificity is approximately 90%. The relative performance characteristics of the most recent assay on a program basis compared to FIT remain unknown.

Flexible sigmoidoscopy has 2 randomized controlled trials to support its use. However, reduced acceptance relative to colonoscopy, and a lack of evidence that it protects against right-sided cancer compared to colonoscopy will continue to keep it in its current position in the United States, in which it receives almost no use. Similarly, double contrast barium enema seems finished for screening, even though it was still endorsed in the last of version of the US Preventive Services Task Force guideline.

CT colonography was not approved in the last version of the US Preventive Services Task Force guidelines, because of concerns about net harms associated with radiation risk and extra colonic findings. Relatively strict protocols for management of extracolonic findings have reduced the burden of these finding, and in some cases these findings appear to produce benefit, particularly for asymptomatic extracolonic cancers (primarily renal cell) and large abdominal aortic aneurysms. Political forces in the United States have resulted in an interest in CT colonography at the US Food and Drug Administration. Considerable pressure has been applied to the US Preventive Services Task Force to re-evaluate its position on CT colonography.

The first intensively studied serum assay for colorectal cancer screening is the Epigenomics assay for Septin 9. In a 7000 patient screening colonoscopy trial the sensitivity of the Septin 9 assay for cancer was 48%, and for advanced adenomas 11%, with specificity of 90%. Effectively, the assay has no sensitivity for advanced lesions, is less effective and much more expensive than FIT, but as the first serum assay might get some use for patients who refuse other forms of testing.

As the understanding of colonoscopy continues to evolve, there may be continued interest in its use for screening if it is established that high quality colonoscopy remains more effective than any other form of screening. Thus, in the hands of a high-level detector, colonoscopy may have the advantages of more than 20 years of protection from cancer, superior detection of flat and depressed, and serrated lesions, compared to other technologies. There may be gains in cost-effectiveness if there is continued development of further expansion of intervals between examinations. The resect and discard policy for diminutive polyps, and alternatives to the use of anesthesia specialists for sedation. The development of new payment models such as reference or bundled payment in the United States, may overcome objections to colonoscopy based on cost.

CALL FOR ABSTRACTS SUBMISSIONS

Self-expandable metallic stent placement plus laparoscopy for acute malignant colorectal obstruction JIAMIN ZHOU, DEPARTMENT OF ENDOSCOPIC CENTER, ZHONGSHAN HOSPITAL, FUDAN UNIVERSITY, SHANGHAI, CHINA

BACKGROUND: Self-expandable metallic stent (SEMS) place-ment can increase the probability of performing laparoscop-ic colectomy for colorectal cancer (CRC) patients with acute colorectal obstruction (ACO). However, SEMS placement was believed to make the laparoscopic procedure more difficult and the long-term survival of patients undergoing stent-laparoscopy is still unknown.

AIM: To investigate the clinical advantages of the stent-laparos-copy approach to treat CRC patients with ACO.

METHODS: From April 2008 to April 2012, surgery-related pa-rameters, complications, overall survival (OS), and disease-free survival (DFS) of 74 patients with left-sided CRC presented with ACO who underwent SEMS placement followed by one-stage open (n = 58) or laparoscopic resection (n = 16) were evaluated retrospectively. The stent-laparoscopy group was also compared with a control group of 96 CRC patients who underwent regular laparoscopy without ACO to explore whether SEMS placement would influence the laparoscopic procedure or reduce long-term survival by influencing CRC oncologic characteristics.

RESULTS: The rate of conversion to open surgery was 12.5% in the stent-laparoscopy group. Bowel function recovery and postoperative hospital stay were significantly shorter (P = 0.016 and P = 0.005), and surgical time was significantly longer (P = 0.045) in the stent-laparoscopy group than in the stent-open group. Surgery-related complications and rate of admission to the intensive care unit were lower in the stent-laparoscopy group. There were no significant differences in the interval be-tween stenting and surgery, intraoperative blood loss, OS, and DFS between the two stent groups. Compared with those in the stent-laparoscopy group, all parameters in the control group were comparable.

CONCLUSIONS: The stent-laparoscopy approach is a feasible and minimally invasive option for patients with ACO caused by left-sided CRC and can achieve a favorable long-term prognosis.

ABSTRACT SUBMISSIONS WERE ENCOURAGED FOR THE FIRST TIME THIS YEAR AND ARE DISPLAYED BELOW

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ABSTRACT SUBMISSIONS WERE ENCOURAGED FOR THE FIRST TIME THIS YEAR AND ARE DISPLAYED BELOW

Notes

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You will be given instructions on how to login and invited to set up your password once registered.Mobile web app: SIES2014.showgizmo.mobi

If you have allowed ‘show app profile’ at registration, you will be able to go to your profile and update it, view other profiles, look at the most up-to-date information and much more.

Complimentary Wi-Fi is available for all delegates,

courtesy of Boston Scientific

Password: SIES2014

SIES 2014 APP

Search for SIES2014 in your app store

SIES 2014

KINDLY BROUGHT TO YOU BY

#SIES2014

FREE WIFI

This year The Symposium is delighted to provide our custom made SIES 2014 App to mobilise our event – putting all the information in the palm of your hand and allowing you to connect with all other delegates.

To get the SIES App on your mobile device, simply go to your App Store on your iPhone or Android and search for ‘SIES 2014’.

Once downloaded, choose our event from the list/sign in and create a profile. (if you haven’t done so already)

Alternatively anyone can use the Mobile Web version of the app by opening the web browser on your phone, tablet or laptop e.g. Safari and going to SIES2014.showgizmo.mobi

Before the event:

• Edit your personal profile so people can find you. Include information, contact details, photos, attach documents and list multiple URL links. You decide what information is made public.

• Use SIES 2014 App to browse the list of exhibitors and sponsors.

• Arrange meetings with other delegates or exhibitors.

• Join in the conversation using Twitter, or post messages to our live event feed.

• Ensure you have your APP QR Code badge visible allowing others to connect to you.

During the event:

• Displaying your QR Code allows fellow delegates to scan you and swap contact details

• Include personal websites, social media sites or event specific pages on your profile to increase connections at the event.

• ‘Favourite’ the speakers you enjoyed the most. Rate their sessions and download/share their presentations.

• Get real time updates and push notifications from the event producer and exhibitors during the day.

• Tweet using the event hashtag #SIES2014 so your conversation is displayed within the app.

• Post messages to fellow attendees, to speakers or to the event organiser in the live event feed

• Use the integrated floor plan to find your way around the event with ease.

• Take notes during conference sessions

• Participate in live polls to give speakers or the organiser your opinion

• Use the SIES 2014 App offline to save data charges.

After the event:

• View all your favourited information easily by logging into my.showgizmo.com or in the app up to 12 months later.

• Complete the post event survey

Visit the SIES 2014 App Concierge Booth opposite the registration desk for more information or get help with registration.

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©2013 Boston Scientific Corporation or its affiliates. All rights reserved.ENDO-000000-XX September 2013

The procedure isn’t a success if the clip fails.

For more information, contact your local representative, visit www.bostonscientific.com/endo-resources

*Data on file

Resolution is a registered or unregistered trademark of Boston Scientific Corporation or its affiliates.

©2013 Boston Scientific Corporation or its affiliates. All rights reserved.

ANZ_PSST_13122 Rev AA December 2013

With more than 4 million clips placed,more than 220 clinical articles published,and almost a decade of proven clinical efficacy,why would you trust anything else?*

Resolution™ ClipLeave nothing to chance™

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TRADE FLOOR PLAN

Previous issuesabove 2480

REGISTRATION

APPCONCIERGE

DESK

THE HILTON SYDNEY HOTEL GRAND BALLROOM

PLATINUM SPONSORS

3. AbbVie

4. Boston Scientific

2. Cook Medical

8. Device Technologies

1. Olympus

SILVER SPONSORS

26. Abbott (Thursday/Friday)

22. AstraZeneca

9. Endotherapeutics

20. Ferring Pharmaceuticals

12. Flolite

11. Fresenius Kabi

21. Janssen

5. MediVantage

23. MedTech

6. Norgine

25. Orphan

14. Shire

10. Vitramed

NURSES’ WORKSHOP SPONSORS

8. Device Technologies

24. GENCA

26. Whitely Corporation (Wednesday)

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7 6 5

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23222120

GOLD SPONSORS

16. Covidien

15. CR Kennedy

17. Endomed

13. Gallay

18. Given Imaging

7. Pyramed

19. Rymed

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8

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THANK YOU

WESTMEAD SIES TEAM

CERTIFICATES OF ATTENDANCE

If you would like a Certificate of Attendance, please add your name to the list at the Registration Desk. These will be sent via email after the Symposium.

19

This is to certify that

attended the above event as a registered Delegate and attended the following sessions:

THURSDAY 6th MARCH 2013

Day 1 Sessions

FRIDAY 7th MARCH 2013

Day 2 Sessions

Prof Michael BourkeChairman Sydney International Endoscopy Symposium 2014

Director Gastrointestinal Endoscopy Westmead Hospital, Sydney, NSW

C E R T I F I CAT E O F AT T E N DA N C E

Sydney International Endoscopy Symposium

Thursday 6th & Friday 7th March, 2014

Hilton Sydney, AustraliaIncorporating the Westmead Endoscopy Symposium Nurses’ Workshop – Wednesday 5th March, 2014

Thursday 6th & Friday 7th March

2014

7th

WESTMEAD CONSULTANT ENDOSCOPISTS

Assoc Prof Golo Ahlenstiel

Prof Michael Bourke

Dr Rick Hope

Dr Vu Kwan

Dr Thao Lam

Dr Eric Lee

Dr Rita Lin

Dr Nghi Phung

Dr David Ruppin

Dr Dev Samarasinghe

Dr David van der Poorten

Dr Stephen Williams

WESTMEAD MEDICAL PRODUCTION AND CO-ORDINATION

Dr Farzan Bahin

Dr Nick Burgess

Dr Vikas Gupta

Dr Amir Klein

Dr Crispin Musumba

Dr Kavin Nanda

Dr Adrian Sartoretto

Ms Rebecca Sonson, RN

Dr Praka Sundaralingam

Dr Nicholas Tutticci

SYDNEY WEST AREA HEALTH SERVICE AUDIO VISUAL PRODUCTION TEAM

Garry Burns

Simon Davies

Phil Edwards

Terry Lawrie

Jon Munro

WESTMEAD ENDOSCOPY CLERICAL AND TECHNICAL SUPPORT TEAM

Shamim Ara

Ramona Galea

Ewa Kasprzak-Adamecki, ST

Alvi Mackole

Nancy Natoli

Lila Wati Singh, ST

Andie Fan Yi, ST

SPECIAL THANKS TO:

Westmead Department of Anaesthetics – Prof Peter Klineberg and Dr Susan Voss

WESTMEAD NURSING STAFF

Adenike Adeyemi, RN

Alison Bannister, RN

Mary Bong, NUM

Robyn Brown, CNE

Octavio Ferrer, RN

Kerry Flew, CNS

Stephanie Henshaw, EEN

Jenevieh Junio, RN

Marriam Khilwati, RN

Sandra Ko, RN

Susan Lane, RN

Polly Leong, RN

Helna Lindhout, RN

Betty Lo, RN

Pauline Luxford, RN

Vanessa McArdle-Gorman, RN

Kwok Siu, RN

Nicky Stojanovic, RN

Amelia Tam, RN

Judy Tighe Foster, CNS

Helena Tsang, RN

Su Wang, RN

Janice Waru, RN

Matthew Whitbred, RN

Conference Organiser and SecretariatFor further information please contact

e-Kiddna Event ManagementPh +61 7 3893 1988Fax +61 7 3337 9855 email: info@e-Kiddna.com.au

Thank you to our sponsors:

Disclaimer: Information contained in this brochure was correct at the time of publication. However, it may be necessary, due to unforeseen circumstances for sections to be changed. The organisers will endeavour to keep changes to a minimum.

PLATINUM SPONSORS

GOLD SPONSORS

SILVER SPONSORS

NURSES’ WORKSHOP

PTY LTDPTY LTD

est.1978

SIES 2014 APPSPONSOR