December 2015

New Zealand Society of
Gastroenterology
In This Issue:
PAGE 1
- Update from Your
President
- Editorial from Michael
Schultz
PAGE 2
- 2015 Conference
Award Winners
PAGE 3
- 2015 Research Grants
and Fellowship
PAGE 4
- From the Past
PAGE 5
- ASM 2016
PAGE 6
- 2015 ASM by Richard
Newbury
- Professor Ed Gane Okuda Lectureship
Issue: 30
Update from Your President
December 2015
So another 3 months goes by. The world and we grow a little older
and wiser. Or is it more cynical? Anyway I hope you enjoyed this
year’s Annual Scientific Meeting in sunny Rotorua. We had 320
registered delegates, which is a fair turnout for a meeting outside a
Big City. We had a great set of International speakers who said good
things about the standard of our home research and presentations.
Congratulations to all participants.
The inevitable look back on the year is tainted a little by the report of
a second year in financial deficit, with a further shortfall forecast for
next year. Although the Society’s gross assets remain healthy we
have had to tighten our belts and cut back on expenses, ask for an
increase in revenue from Membership Fees and restrict the small
Grants to $20,000 next year.
In order to help foster our relationship with Pharma we held a pre-ASM “Successful Partnerships”
meeting with them at which Emeritus Professor Gil Barbezat drew an overview of the society’s
history and Michael Schultz and I outlined the many activities that the NZSG are involved in, from
fostering research, to organizing Endoscopy and Special Topic meetings to representations to
PHARMAC. We will now enter into further negotiations on how future sponsorship can be raised
and how it should be targeted. Talking of PHARMAC we are working on a proposal that we should
have access to an alternative Biological Agent for a TNF-failure patients, and will also lobby for
the ability to use Rifaxamin in SIBO. Other ideas are welcome. On Endoscopy Governance front
I believe we have moved into a closed understanding with the Ministry of Health, and partly as
a result of this hope to be able to announce a new Clinical Director for NEQIP (or its daughter
organisation) in the new year. Central funding for EGGNZ may be coming and so you can should
keep up the GRS activities, for a probable audit in March 2016.
Anyway , it’s time to relax with family time for a few weeks. I wish you all a happy and safe holiday
season. Enjoy.
Russell
PS if you want the full 296 pictures from the ASM please get your HoDs to contact Anna Pears
for a CD.
Editorial
Closing Soon
Research Grants!
The next round of
applications closes on
31 January 2015 (See
page 5 for
more information)
Welcome to this last edition of the NZSG newsletters. 2015 was an
exciting year for the gastroenterological community but it is now slowly
winding down. Hopefully, 2016 will bring some certainty to the bowel
cancer screening program, endoscopy quality assurance and many other
important issues. The ASM in Rotorua was the society’s highlight of the
year with an exciting invasion of storm troopers, weird and wonderful
Princesses Leias, Chewbaccas and colorful Avatars at the dinner. In this
issue, Richard Newbury will summarize the highlights of the meeting
and Jim Brooker will wet our appetite to descend onto Hamilton in force
for the ASM and the society’s 50th birthday bash. Leading up to this
milestone, Bramwell Cook presents the second part of ‘The Beginning of
Gastroenterology in New Zealand’. Dr Andrew McCombie and Dr Ely Rodrigues, the winners of
the two major 2015 research awards outline their research plans and we are looking forward to
their presentations at next years’ ASM. Finally, I hope you enjoyed reading this years’ newsletters.
As always, if you have an interesting topic for discussion, and exciting article or even just a photo,
please get in contact with Anna Pears to have them included in the next newsletter. This brings
me to the point where I would like Anna very much for all her support throughout the past year. A
lot would not have happened as smoothly as it did without Anna. Finally, I would also like to thank everybody for their trust in voting for me as President-elect.
Have a Merry Christmas and a Happy New Year.
Michael
Page 1
2015 NZSG ASM Awards and Winners
Award
NZSG Janssen Research
Fellowship
Winner
Andrew McCombie/Walmsley/
Barclay/Schultz:
Prize
$65,000
A multicentre pilot study of use of
smartphone-based health applications
IBDSmart & IBDoc in the care of IBD
patients in NZ
NZSG AbbVie Research Grant
Ely Rodrigues/Butt/Schultz:
$35,000
How does Crohn’s Disease modify the
response of the intestinal epithelium to
commensal bacteria ?
NZSG Best Luminal Paper/
Poster
Tim Angeli:
AbbVie Best Hepatology
Paper/Poster
Lily Wu:
Gastric ablation as a novel therapeutic
option for modulating gastric electrical
activity
Prognostic factors of survival and recurrence
of hepatocellular carcinoma treated with
curative intent
Andrew McCombie recieving the 2015
NZSG Janssen Research Fellowship from
Lissa Gilliver, Senior Product Manager,
Janssen-Cilag Ptg Ltd
Page 2
$1,500
$1,500
Ely Rodrigues 2015 NZSG AbbVie Research Grant
How does Crohn’s Disease modify the response of the intestinal
epithelium to commensal bacteria ?
Lay Abstract
Humans and their intestinal microbiota peacefully coexist in a lifelong, bidirectional and symbiotic relationship. The
intestinal tract is an example of this relationship hosting an excess of 1014 resident bacteria that play an active role in
shaping the host’s physiological processes, such as the immune system and intestinal barrier properties, enabling
it to maintain constant vigilance against harmful pathogens while at the same time preventing the development of
uncontrolled inflammation as seen in Inflammatory bowel disease. The Intestinal epithelium regulates the interaction
between the intestinal bacteria and intestinal immune system by physically separating the intestinal milieu from the
gut lumen and also via active mechanisms such as microbial recognition (pattern recognition receptors), production
of anti-microbials (e.g. defensins, lectins, cytokines) and mucus (mucins). While a lot is known about effect of Crohn’s
disease (CD) on the intestinal epithelium and the microbiome associated with CD, little is known about the affect
the interaction of the epithelium with the microbiome has on the development of CD. Preliminary data obtained
from enteroids derived from control non-CD patients indicate that bacterial components can modulate goblet cell
development, thus affecting the mucus layer, in the intestinal epithelium. We also know that in addition to modified
expression if TLRs, there is also a TLR4 polymorphism associated with CD. In this project we will use novel cell
culture techniques to grow intestinal stem cell derived epithelial organoids from healthy individuals and CD patients.
In this project we will determine how CD modifies the response of the intestinal epithelium to commensal bacteria
and how complex interaction with the commensal microbiome leads to and impaired barrier resulting in a severe
inflammation.
Andrew McCombie 2015 NZSG Janssen Research
A multi centre pilot study of the use of smartphone-based health applications
IBDsmart Progress report
In short, this study is about using two smartphone apps, namely IBDsmart and IBDoc®, to monitor inflammatory bowel
disease (IBD) patient symptoms and faecal calprotectin on a regular basis respectively. In the IBDsmart app, the
sCDAI, HBI and DISQ (Dudley Intestinal Symptom Questionnaire) are used to monitor Crohn’s disease while SCCAI
and DISQ are used to monitor ulcerative colitis.
In order to add an objective measurement, IBDoc®, a smartphone platform that allows remote, point-of-care,
monitoring of faecal calprotectin, has been added to IBDsmart. A randomised clinical trial has been designed aiming
to recruit 102 patients in three centres nation-wide (Dunedin, Christchurch and Waitemata). This study has been set
up as a randomized controlled trial to measure non-inferiority between two groups (IBDsmart/IBDoc® user vs control).
These groups are patients using IBDsmart and IBDoc® to report symptoms and faecal calprotectin remotely (i.e. via
a smartphone and in substitute of scheduled face-to-face outpatient appointments) on a three monthly basis and
treatment as usual (i.e. normal face-to-face appointments as often as their specialist would normally see them). In
cases of flare, IBDsmart/IBDoc® users will report this via their smartphone while those in the treatment as usual group
will report this using their normal method (e.g., phone call, GP visit, etc).
The two groups will be compared in terms of symptoms (using the validated clinical indices HBI and SCCAI) and
quality of life (IBDQ) over a one year period and it is anticipated that there will be no differences between the groups
in terms of these outcomes; if the smartphone app group has a better quality of life or reduced symptoms compared to
the treatment as usual group during the study period this would be a bonus. We are also measuring the acceptability
of the apps for patients and doctors alike and to see whether patients and doctors think this is something we could
do more of in the future. In light of bowel cancer screening and rising rates of IBD in New Zealand and worldwide
leading to increased demand for colonoscopies and gastroenterology outpatient appointments, the outcome of this
study is crucial for improving the efficiency of the outpatient care of IBD patients. Relatedly, if face-to-face outpatient
clinics can be reserved for more symptomatic and actively diseased patients, there are potentially significant costeffectiveness implications.
From the Past - the beginnings of gastroenterology in New Zealand
In 1941, the Genito-Urinary Manufacturing Company devised a gastroscope for Hermon Taylor, a London surgeon. It
had a flexible distal portion which, with proximal controls, greatly reduced the areas of the stomach that were difficult
to visualise directly. This involved a longer rigid steel segment than Schindler’s gastroscope, and the flexible part of
the gastroscope was 2mm wider – 14mm – and appreciably stiffer. By means of longitudinal wires, the flexible portion
of the scope could be moved forwards and backwards up to the limit of optical flexibility, an innovation still used in
gastroscopes today.
In 1945, Francis Avery-Jones (later Sir Francis) at the Central Middlesex Hospital, London, wrote favourably of this
gastroscope:1 ‘The Hermon Taylor model gives a much better view of the stomach than can be obtained with the
Wolf-Schindler instrument, and we consider it is the gastroscope of choice provided it is passed with care.’ ‘Passed
with care’, was crucial, for the risk of oesophageal perforation was apparently greater with the Hermon Taylor than
with the Schindler gastroscope.
Early gastroscopes were limited by the difficulty to visualise the stomach completely and the inability to biopsy lesions.
As early as 1940, Bruce Kenamore devised a system to clamp forceps onto the shaft of a Schindler gastroscope.2
However, this not considered to be safe. In 1948, Edward B Benedict, a Harvard Medical School surgeon, together
with American Cystoscope Makers Inc, was the first to design a gastroscope that had an in-built channel to pass
biopsy forceps and which could also be used as a suction tube.3 Controls at the proximal end raised and lowered the
biopsy forceps elevator at the distal end. The shaft of this well-worn was oval in shape. Problems with its size and
the elevator made the gastroscope of little practical value.4 The instrument’s mirror was small, allowing a limited look
at the gastric mucosa. The instrument lacked the innovation introduced in the Hermon Taylor gastroscope, to flex
the distal portion forwards or backwards. By today’s standards, the bite of the biopsy forceps was large. Benedict’s
residents unkindly called this sword-like device the ‘Benedict Blind Perforating Gastroscope’.5
It is probable that Tom Anderson used these instruments, although we have no records to confirm this. We do not
know what he thought of the ‘Blind Perforating Gastroscope’, and if he biopsied gastric lesions. The Museum also
holds an Eder gastroscope, first made in 1945, and an Eder-Hufford oesophagus, first made in 1949.
Page 4
continued from page 4...
NZSG Small Research Grants
(Endnotes)
The NZSG is keen to encourage clinical
research by gastroenterology and surgical
trainees during their period of clinical training.
Supervisors may have the ideas and time but
need small grants for tests, equipment or parttime staff.
Fletcher CM, Avery Jones F. The risks of
gastroscopy with the flexible gastroscope. Brit
Med J. 1945; ii: 421–2.
1
Kenamore B. A biopsy forceps for the
flexible gastroscope. Am J Dig Dis. 1940; 7: 539.
The next round of applications closes on 31
January 2016. For more information on the
eligibility, conditions and application process,
please go to the NZSG website www.nzsg.org.
nz.
2
Benedict EB. An operating gastroscope.
Gastroenterology. 1948; 11: 281–3.
3
DiMarino AJ, Benjamin SB, editors. Gastrointestinal disease: an endoscopic approach. 2nd ed.
Slack Inc, NJ, USA, 2002. p 6.
4
Fischer JE, Bland KI, ed. Mastery of surgery. Vol I. Philadelphia, Lippincott Williams and
Wilkins, 2007.
5
ASM 2016
We look forward to welcoming you back to
Hamilton for the 2016 NZSG ASM, once again
based at the superb Claudelands Event Centre.
Plans are already well under way with a distinguished line
up of international and national speakers, so far including
•
Michael Camilleri, Current President of the American
Gastroenterology Association
•
Ian Norton, President Elect of GESA
•
Michael Kamm, Melbourne
•
Stuart Roberts, Melbourne
•
Mark Appleyard, Brisbane
•
Rachel Wundke, Adelaide
An exciting program is being developed which will cover
a wide range of topics including functional GI disorders,
advances in diagnostic and therapeutic endoscopy, an
endoscopy video forum and prize, hepatobiliary and EUS,
anticoagulants and antiplatelet therapies and endoscopy.
There will be a capsule endoscopy symposium, an IBD
dinner meeting and a viral hepatitis dinner meeting. Other
topics covered include complications of liver disease,
bowel cancer screening and hereditary GI cancers. As
usual the highlights of the social program will include the
Great Guts Fun Run/Walk, and the showpiece conference
dinner, themed “Waikato - from Bogans to Royalty”. We have an enthusiastic medical and nursing
organizing committee determined to make the
conference appeal to a broad range of attendees.
We look forward to welcoming you to the conference.
Jim Brooker
Conference Convenor
Page 5
2015 NZSG ASM
And breath out..
It’s been and gone another ASM just like that, but judging by remarks
thus far, the meeting was enjoyed by most. Since we are a small Gastro
team in Rotorua we are especially grateful for the help that came from
many quarters.
It started with the Powhiri led by Eru George; Rotorua Intermediate
School proudly roused emotion and a positive energy that created
momentum. James Ward delivered the opening plenary talk, giving us
cause to consider a different perspective when comparing differences in
the health of the first peoples of Australia. Anne Murphy’s detailed talk
on Bowel Cancer Screening worldwide felt pertinent at this juncture.
Then Nina Scott sobered us up with her raw insight into ethnic biases
continuing our emotional rollercoaster!
Rupert Leong deserved a medal. Not only did he fill Siew Ng’s shoes,
who we hope is making a full recovery, but he also delivered on several talks with apparent ease. Explaining where we
are in our understanding of the multifactorial aetiology of IBD, through epidemiological studies. He also commented
on the quality of the free paper talks, quite a complement to the presenters and congrats to the prize winners.
Paul Fockens reported that the pre-conference POEM workshop worked out rather well; despite unearthing some
particularly challenging cases, perfect, nice work Jim! Paul also gave several talks at the ASM, one particularly stood
out for me on the relative importance of standards in screening and polyp detection. This overview was reassurance
that invested efforts in quality being led by gastroenterologists around NZ will be a key component to a successful
BCS roll out.
Chrissy Rees, Nurse Convenor commented that a smile never seemed to leave Michael Heneghan. He was an
absolute delight and apparently we managed to remind him what the old Gastro conferences were like in Ireland when
he was a registrar! He delivered talks on areas such as liver disease in pregnancy and Autoimmune Liver Disease
with great deftness, as you might expect. I would particularly like to thank our national speakers, having tried to thank
all individually, you are the back bone of the ASM and it bodes well that the standard seems to reach a new high year
on year. Also to the inimitable David R, special thanks for stepping in at the last minute and applying your humour to
the debate.
And we had a conference dinner. Many commented that they liked the band, Cairo. Nurses, doctors, industry and
international guests all got into the spirit of the annual dinner! Is there a better specialty to be associated with in NZ?
Costumes included jaw dropping Princess Leias, a pouting cross dressing Lieutenant Ohara, an unusually partially
clothed Alistair looked the part as C3PO, extraordinary Storm Troopers, a scary Dutch Darth Vader, and Avatars with
the longest tails and broadest smiles. All photographs of the dinner, run and opening session are to be available for
all soon.
Russell without your Russell-ness we would have been so much the poorer. Michael S, thank you for all your guidance,
especially with those later teleconferences. Claire Bark, Tangerine Events, you were the bees knees, true to form. To
all who attended, I hope you had as much fun as we did! Have a wonderful Christmas and see you in the New Year.
Richard Newbury
Conference Convenor
ANZGITA
Australian and New Zealand gastroenterologists and
gastroenterology nurses have been providing training in the
Pacific and Burma for the past 8 years under the auspices of the
Australian & New Zealand Gastroenterology International Training
Association (ANZGITA). This has led to significant improvements
in the standard of gastroenterology services in these countries. ANZGITA has the following training programs and need
trainers:
•
•
Professor Ed Gane delivering the
Okuda Lectureship on “Advances in HCV
Therapy - Towards Global HCV Elimination” at
AAPDW
Yangon 10-23 February 2016
Page 6
Suva 11 July - 5 August 2016 (But it is possible that it
will be moved to 1-26 August)
At this stage it appears that there will not be any financial
support for trainers in Yangon and only limited support for those
who are selected for Suva.
If you are interested please contact tony.clarke@anzgita.org
2015 NZSG ASM Dinner Photo Album
What a Night
Merry Christmas and Happy New Year