Inaugural Meeting of the Society of Gastrointestinal Intervention

Abstract

The Society of Gastrointestinal Intervention was founded to provide a multidisciplinary forum for medical staff, scientists and allied health professionals involved in minimally invasive gastrointestinal intervention. Besides providing an international meeting, the society aims to establish a clinical, as well as an academic network among the three main disciplines of gastroenterology, surgery and interventional radiology. A further aim is to promote collaboration between healthcare professionals and industry.

The inaugural meeting was titled ‘The Cutting Edge of Gastrointestinal Stenting’ and consisted of 39 lectures by experts from around the globe with associated panel discussions. This was supplemented by a session on ‘English Expressions at the Podium’ and a scientific poster exhibition. The 2 day meeting was held in the Asan Medical Centre in Seoul, which is a 2000-bed University Hospital with excellent conference facilities. The meeting was split into sessions on esophageal intervention, gastroduodenal intervention, colorectal intervention, pancreatico–biliary intervention and plenary lecture sessions. The executive committee (President: Andy Adam, London, UK; Secretary General: Ho-Young Song, Seoul, South Korea; Vice-Secretary General: DonKi Lee, Seoul, South Korea) and their organizing committee of 65 experts from ten countries had put together an inspiring selection of presentations from experts in the field. The particular strength of this meeting lay in its multidisciplinary representation, and one of the strongest messages was the need for the collaboration between endoscopists, surgeons and radiologists. The meeting had over 500 registrants from 15 different countries and 72 posters were accepted for display.

Esophageal intervention

In the first session the expanding application of modern stent designs were illustrated. David Shepherd demonstrated how modified removable stents allow stenting of even high cervical esophageal strictures. However, easy access to endoscopy for patients who do not tolerate the stent must be ensured.

The use of valved stents across the gastro-esophageal junction to prevent reflux and aspiration was still very much under debate. Although intuitively appealing, the evidence for this concept is still thin and a consensus could not be reached. Hopes were expressed from the UK that the national Registry of Oesophageal Stenting (ROST) might shed light on this issue in the future [1].

The use of removable stents for temporary stenting of benign strictures was now accepted as an established second-line treatment, although this is may be superseded by the advent of the first biodegradable stent.

The routine use of removable stents for malignant strictures was advocated by Sung-Gwon Kang on the basis of better management options for misplaced or migrated stents and reduced complication rates when compared with attempts at removing standard metal stents.

Andy Adam illustrated the challenges of esophageal fistulas and perforations, which are technically easy to stent, but clinical outcome is often poor due to comorbidity.

Palliative stenting of malignant fistulas seems an acceptable strategy, but benign perforations are usually better treated by other means.

Whereas Roger Frost advocated balloon dilatation for the treatment of achalasia as a well established first-line treatment, Ying-Sheng Cheng indicated good results in a Chinese population with temporary placement of removable antireflux stents. However, further modifications in stent design are probably required before this can be regarded as a standard treatment.

Gastroduodenal intervention

Two sessions of five lectures each occupied the middle of the day consisting of technical tips for endoscopic stent placement (Todd Baron) and fluoroscopic placement (Jorge Lopera).

Stent placement has been accepted as a first-line treatment for malignant gastoduodenal obstruction on the basis of its immediate clinical success and low morbidity. Rodrigo Castano presented the current evidence from the literature, which is of low grade, involving less than 400 procedures. Scientific verification of this concept requires randomized studies or large scale audits.

The importance of a full understanding of postsurgical anatomy after gastric cancer resection was outlined by Iruru Maetani. Anastomotic recurrence requires careful assessment of both limbs of the gastroenterostomy and often radiological as well as endoscopic assessment.

By contrast to the esophagus, most operators currently use bare rather than covered enteral stents. New designs combine separate layers of metal struts and covering membranes. These constructions reduce stent shortening and increase flexibility as well as allowing a better grip of the intestinal mucosa on the stent. In parallel, the current problems of tumor ingrowth into the uncovered mesh are avoided. The need for careful planning of covered stent placement around the Papilla of Vater was repeatedly emphasized.

Benign enteral strictures are currently still regarded as a contraindication to placement of self-expanding stents, although the arrival of biodegradable stents may offer further opportunities. Hans-Peter Strecker demonstrated the latest developments in stent delivery systems, incorporating a hydraulic rather than a pullback system, and the continued efforts in stent development were well illustrated on the stands of the exhibitors. It became quite clear that Korean companies are now at the forefront of stent technology and are benefiting from close collaboration with the universities and clinical specialists.

Colorectal intervention

The final session of the first day consisted of several video sessions on endoscopic and fluoroscopic stent placement in the large bowel. Furthermore, a wide variety of speakers from Europe, USA and Asia gave a fantastic overview of current indications and limitations. Particular attention was paid to the increasingly popular ‘bridge-to-surgery’ approach. Initial stenting in acute colonic obstruction followed by semi-elective tumor resection reduces surgical complications, mortality and the requirements for colostomy.

The first day was concluded by the banquet. From a personal point of view it was an awe-inspiring experience to mingle with the authors of most mainstream papers on gastrointestinal stenting. The banquet itself was a memorable introduction to Korean cuisine, followed by an awards ceremony for the outstanding efforts of the organizing committee.

Biliary intervention

The morning of the second day was occupied by two sessions on pancreaticobiliary intervention. Philosophies for endoscopic and percutaneous management of biliary obstruction were described from Asia, Europe and America and the particular need for a multidisciplinary approach in this context became very clear. Discussions particularly benefited from the input of endoscoping radiologists from the UK. One of the strongest messages was not to only plan for the current procedure, but for the next procedure when the stent may have failed.

An increasing number of benign biliary strictures are now seen after liver transplantation. An alternative approach using balloon dilatation of the Sphincter of Oddi rather than sphincterotomy was described by Hiroyoyuki Isayama who suggested improved outcome by preserving sphincter function. GI-Young Ko described good results with long-term external drainage, using tubes of increasing size. However, this effect clearly has limitations for the patient. Whether biodegradable stents will become the way of the future has to be determined.

The particular challenges of multiple and recurrent intrahepatic bile duct stones in a South African population were discussed by Steve Beningfield. Metal stent insertion for limiting benign strictures is fraught with difficulty and these patients require imaginative application of other, reversible methods.

After lunch, the best poster prize was awarded to Ai-Wu Mao for the paper titled ‘A prospective evaluation of a new designed esophageal stent for the management of cervical esophageal strictures’. This was followed by lectures and a panel discussion on presenting papers and moderating sessions in English. Although a rather unusual topic, this session turned out to be extremely entertaining and was voted to be one of the most useful sessions by the audience. The meeting was concluded by three plenary lectures on future technologies and innovations:

•	Krishna Kandarpa illustrated the technological advance in interventional radiology and the increasing number of applications of interventional radiology, which confirm this as a specialty in its own right, increasingly challenging traditional surgical methods;
•	Richard Kozarek discussed the possibilities for future stent materials and constructions, and further evolution of endoscopy and its technique;
•	Ho-Young Sung gave an inspiring overview of the milestones of his career, which in the humblest of fashions illustrated what an inquisitive mind paired with the need for constant improvement can achieve. To my mind one of his greatest achievements was to help establish a local stent industry in Columbia, where imported stents are not affordable.

The Society of Gastrointestinal Intervention (SGI) 2007 stood out as an incredibly well-organized meeting providing an unusually detailed overview of a specialized subject, yet making this accessible to an audience of all levels of expertise from allied healthcare professionals to trainees and experienced specialists. One aim of SGI is for this meeting to be attractive to trainees of the relevant specialties and junior doctors should make use of the opportunity to have access to this huge combined expertise. In addition, the social and cultural events available, paired with the Korean hospitality made this a truly memorable experience.

SGI 2008 is scheduled for the 10th and 11th of October 2008 in Seoul, details can be found online [2].

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.