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Supplementum 225 (September 12, 2017) SMW Established in 1871 Swiss Medical Weekly Formerly: Schweizerische Medizinische Wochenschrift An open access, online journal • www.smw.ch Supplementum 225 Annual Meeting Swiss Society of Gastroenterology (SGG-SSG) ad Swiss Med Wkly Swiss Society of Visceral Surgery (SGVC-SSCV) 2017;147 September 12, 2017 Swiss Association for the Study of the Liver (SASL) Swiss Society of Endoscopy Nurses and Associates (SVEP-ASPE) Lausanne (Switzerland), September 14/15, 2017 Abstracts TABLE OF CONTENTS 1 S Orals 2 S O1–O42 Posters Gastroenterology 13 S PG1–PG27 Posters Hepatology 20 S PH1–PH8 Posters Surgery 22 S PS1–PS19 Index of first authors 28 S Impressum Editorial board: © EMH Swiss Medical Publishers Ltd. All communications to: Listed in: Prof. Adriano Aguzzi, Zurich (ed. in chief) (EMH), 2017. The Swiss Medical Weekly EMH Swiss Medical Publishers Ltd. Index Medicus / MEDLINE Prof. Manuel Battegay, Basel is an open access publication of EMH. Swiss Medical Weekly Web of science Prof. Jean-Michel Dayer, Geneva Accordingly, EMH grants to all users Farnsburgerstrassse 8 Current Contents Prof. Douglas Hanahan, Lausanne on the basis of the Creative Commons CH-4132 Muttenz, Switzerland Science Citation Index Prof. André P. Perruchoud, Basel license “Attribution – Non commercial – Phone +41 61 467 85 55 EMBASE (senior editor) No Derivative Works” for an unlimited Fax +41 61 467 85 56 Prof. Christian Seiler, Berne period the right to copy, distribute, dis- [email protected] Guidelines for authors Prof. Peter Suter, Genève (senior editor) play, and perform the work as well as to The Guidelines for authors are published make it publicly available on condition on our website www.smw.ch Head of publications that (1) the work is clearly attributed to Cover photo: Submission to this journal proceeds totally Natalie Marty, MD ([email protected]) the author or licensor (2) the work is not © Swiss Tech Convention Center, on-line: www.smw.ch used for commercial purposes and (3) Lausanne. Papers administrator the work is not altered, transformed, or ISSN printed version: 1424-7860 Gisela Wagner ([email protected]) built upon. Any use of the work for com- ISSN online version: 1424–3997 mercial purposes needs the explicit prior authorisation of EMH on the basis of a written agreement. ORALS 2 S Case report: Resection of a large circumferential rectal O1 Gallbladder Derived Stem Cells: A New Chance O3 adenoma with a novel resection system (EndoRotor) Patrick Aepli1, Sandra Hürlimann2, Dominique Criblez1 for Cell Therapy in the Liver 1 Gastroenterology Unit, Luzerner Kantonsspital, Lucerne Felix Baier (1), Adrian Keogh (1), Natalia Lugli (2), Thanos Halazonetis 2 Department for Pathology, Luzerner Kantonsspital, Lucerne (2), Daniel Candinas (1), Deborah Stroka (1) (1) Visceral Surgery Research Laboratory, Department of Clinical Research, Background: EndoRotor is a non-thermal, automated Inselspital and University of Bern mechanical endoscopic resection system designed to remove (2) Department of Molecular Biology, University of Geneva large areas of mucosal tissue in the GI tract. Suction is applied Background Liver disease related mortality has a growing incidence to aspirate and cut the mucosa in small pieces into a catheter- worldwide. Cell therapy has been proposed as an alternative to like device, resulting in a "shaving" resection. The specimens overcome the major drawbacks of the current treatment options. We are automatically transported into a collector for histological recently reported the Gallbladder as a potent source of adult hepatic evaluation. stem cells, which can be expanded in the form of organoids. As pre- Methods: We present a 63-year-old female suffering from requisite for successful engraftment and function in the recipient livers, chronic diarrhea. Colonoscopy showed a flat circumferential we now explore the in vitro differentiation potential of these cells towards adenomatous polyp extending over 3-4 cm in the mid part of the the hepatocyte lineage. rectum. Following perforation of the sigmoid at the initial Methods Adult stem cells are colonoscopy the patient underwent surgical revision. Due to isolated from C57BL/6J mouse severe malnutrition and intraoperative difficulties a definitive gallbladders and expanded in descendostoma was created. As the patient was judged unfit Matrigel. Expansion is based on for further surgery and the rectal adenoma was by no means growth factors including Wnt amenable to established resection techniques such as EMR or activation and TGF-beta inhibition. Differentiation conditions include ESD, this was an indication for an EndoRotor resection. epigenetic modulation, Notch Results: Adenoma resection was primarily judged complete. inhibition, synthetic Hepatocyte Procedure time was 40 minutes. No major complications, i.e. no growth factor or Oncostatin M. KI67 E-Cadherin Dapi bleeding or perforation occurred. Histological workup revealed Modification of the organoid culture medium with differentiation adenoma without high grade dysplasia. Surveillance endoscopy Results promoting factors induced hexagonal cell shapes, multi- nucleation, after 2 months only showed minimal residual adenoma, again decreased proliferation, upregulation of hepatocyte lineage markers treated with EndoRotor resection. Furthermore a clinically (HNF4a, Cyp3a11, AFP, Pparg) and downregulation of stem cell markers irrelevant stenosis at the resection site was noted. (CD44, Sox9). Conclusion: The EndoRotor system is an experimental method that appears to be feasible and efficacious in resecting large flat Conclusions Our current culture protocol allows a differentiation of the rectal adenomas not amenable to established polypectomy organoids towards a hepatoblast-like state. Ongoing refinements of the techniques or surgery. The most important limitation relates to differentiation media formulation may allow the formation of committed completeness of resection; therefore its use is restricted to hepatocyte progenitors in the future. The differentiated cells may then be benign lesions. Histological processing protocols are still under applied in a mouse model of liver failure. evaluation. Prospective studies will be needed to further evaluate this concept. Transoral outlet reduction (TORe) partially reverses weight O2 Evaluation of Controlled Attenuated Parameter (CAP) for Assessment O4 regain after bariatric Roux-en-Y gastric bypass (RYGB). of Liver Steatosis in an Unselected Population: a Single Center Real First clinical experience from a tertiary referral center. Life Experience 1 1 1 2 1 2 2 Stephan Baumeler , Irina Bergamin , Björn Becker , Wolfram Jochum , Dominic Staudenmann , Markus Gass , Cristiana Milone , 2 3 1 2 1 1 Jörg Neuweiler , Rafael Sauter , David Semela Martin Sykora , Dominique Criblez , Patrick Aepli 1Division of Gastroenterology and Hepatology, Hospital St. Gallen, St. 1 Gastroenterology Unit, Luzerner Kantonsspital, Lucerne Gallen Switzerland 2 Obesity Center, Luzerner Kantonsspital, Lucerne 2Institute for pathology, cantonal hospital St. Gallen, Switzerland 3Clinical Trial Unit (CTU), Hospital St. Gallen, St. Gallen Switzerland Background: Bariatric surgery is effective in significantly reducing overweight. However the frequent phenomenon of Abstract secondary weight gain in the further postoperative course Background & Aims: Controlled attenuated parameter (CAP) is a new remains a problem. Progressive dilatation of the gastrojejunal parameter to assess steatosis of the liver, which is obtained together with anastomosis may contribute to the loss of efficacy of RYGB. elastography. Our aim was to assess the performance of CAP in an Recently a novel endoscopic technique called TORe has been unselected population with different liver diseases and define cut off introduced. Full-thickness TORe by an endoscopic suturing values. system (Overstitch, Apollo Endosurgery, USA) enables the Methods: Between March 2015 and August 2016, all patients who endoscopist to reduce the width of the gastrojejunal underwent liver biopsy for any reason were screened to meet the inclusion anastomosis to a diameter of 8-9 mm. Thereby an adaequate criteria. The CAP measurement had to be done within the same week as sensation of postprandial early satiety may be restored, the biopsy and quality standards for CAP measurement were defined. facilitating consecutive weight loss. We report our first clinical Liver biopsies were classified according to the following degrees of experience with TORe procedures. steatosis: S0 <5%; S1 5-33%; S2 34-66%; S3 > 66%. In addition data Methods: Retrospective analysis of 22 consecutive patients about fibrosis, inflammatory activity, body mass index (BMI) and liver suffering from secondary weight gain after bariatric RYGB, disease were recorded. treated with full-thickness TORe from 07/2015 through 06/2016. Results: 290 patients were screened and 224 (77.2%) were included. 146 All patients underwent an interdisciplinary evaluation before the (65.2%) were male. Steatosis grades were distributed as follows S0 n=85 intervention. (37.9%), S1 n=82 (36.6%), S2 n=33 (14.7%), S3 n=24(10.7%). Mean BMI Results: At TORe the mean weight was 98.3 kg (representing was 26.8kg/m2 (SD 5.0), S0 a mean secondary weight gain of 18.7 kg). At 1 month post 24.9kg/m2, for S1 26.5kg/m2, S2 27.3kg/m2 and for S3 32.5kg/m2. The TORe weight loss was 5.8 kg, at 3 months 3.3 kg, at 6 months steatosis- groups S0 to S3 differed significantly with respect to CAP. The AUC for S0 vs S1-S3 was 0.78, for S0/1 vs S2/3 0.83 and for S0,1,2 vs 4.0 kg and after one year 2.0 kg. One operator-related S3 0.82. Cutt-off values for maximal Youden index were 258.5dB/m for S0 perforation occurred, which was immediately and successfully vs S1-3, 282.5dB/m for S0/1 vs S2/3 and 307.5dB/m for S0-2 vs S3. closed by an OTSC, otherwise no complications were noted. Conclusion: TORe is effective in at least arresting or partially Conclusions: CAP shows strong association to steatosis grading. reversing secondary weight gain after bariatric RYGB, as Especially the groups NAFLD/NASH vs other liver diseases and the groups BMI </> 25kg/m2 showed highly significant different CAP values. observed over a follow-up period of 12 months. The procedure appeared to be safe.
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