Virtual Educational Channel

 

 

• Virtual Global interactive Staff Meetings around a clinical case

 

The constraints of the worldwide Covid-19 pandemic require OESO to adapt its educational structure.

A new initiative responds to this need: the OESO-SEMPIRE VIRTUAL EDUCATIONAL CHANNEL.

 

It is built on the basis, already operational, of the OESO-SEMPIRE Platform

coordinating the educational activities of a network of Pilot Centers of Excellence in Esophagology worldwide.

 

Like many of the previous ones, this approach is original, multi-disciplinary, and, from the outset, global.

Its implementation is made possible by use of the virtual techniques of communication available today.

 

Each time, one of the Pilot centers will propose a challenging clinical case open for interactive discussion, followed by the commentary of an invited expert.

The topic and time will be announced well in advance on the OESO website, with specification of the time to allow connection at a comfortable hour of the day.

 

 

Join us,

for an innovative series of international "Staff meetings" with experts from the five parts of the world.

 

The OESO-SEMPIRE virtual channel will welcome, in addition to the Pilot Centers of the network
able to connect, the contribution of

• all the members of OESO,
• other renowned specialists bringing their specific knowledge into the network, whatever their discipline,
• and, more widely, members of the international scientific community.

 

 

• Setting up a meeting

Specifications:

• Transmitted from one of the Pilot Centers of the OESO-SEMPIRE Platform.
• Intended for Pilot Centers in another part of the world, taking into account the time differences.
• Chaired by the Scientific Director of the Center with a member of the junior faculty.
• Short duration: 1-2 hours.

 

Content:

• Presentation of a challenging case in esophagology, preferably involving several disciplines,
  – Exchange of views between the presenters,
  – Discussion with people connected in another part of the world with their audience
     (prior announcements made by the Centers to encourage attendance).
• Invited commentary given by an internationally recognized expert who can also contribute his/her experience to the panel discussion.
  These experts don't have to belong to the OESO-SEMPIRE network.

 

Technology:

• Zoom type technology,
• with announcement well in advance requiring prior signing up of potential participants.
• Courses and discussions recorded and available on the OESO website.

 

• Time zones                                                                                          > Chart download pdf

​

 

Each Pilot Center to choose a preferable time (7-9 am or 5-7 pm) for its program

and know the corresponding time for other Centers wishing to attend the meeting.

 

 

Calendar

 

9th meeting:

Hosted by Prof. Stéphane Bonnet & Brice Gayet

 IMM (Institut Mutualiste Montsouris), Paris

Thursday, April 15, 2021

• Europe: CEST Paris, 4 – 6 pm
• North America: West Coast: 7 – 9 am / East Coast: 10 am – 12 noon
• South America: Sao Paulo 11 am – 1 pm
• Asia: Beijing 10 pm – 12 midnight
• Africa: Bomet, Kenya 5 – 7 pm
• Australia: Melbourne 12 midnight – 2 am (Friday, April 16)
  
  

• Zoom technology applied

Presentation of the case:

• Stéphane Bonnet (IMM)
• Nicole Faermark (IMM)

 

A 68-year-old patient, with intermittent dysphagia to liquids and solids,

painful thoracic spasms and intermittent vomiting. Loss of weight around 15 kg.

 

Diagnosis process:

• CT scan: 5cm long circumferential thickening of the mid thoracic esophagus.
• Endoscopy: pseudo tracheal aspect of the esophagus («trachealization») with multiple rings and no peristalsis.
• Biopsies: normal without eosinophilic esophagitis.
• PET/CT: suspicious 12cm long esophageal fixation (SUV max 15,6).
• Echo-endoscopy: thickening and fusion of wall layers, 36 to 39cm from dental arch.
• High-resolution manometry: impaired relaxation of LES, pan esophageal pressurization pattern.

 

Therapeutic process:

• After multidisciplinary discussions,
  a first series of Botox injections was performed with slight beneficial effect on pain.
• ​Considering the atypical outcome,
  a new echo-endoscopy was performed showing a corkscrew aspect of the esophagus and a pseudo diverticulization between 30 to 42cm from dental arch.
•  Following a new board discussion,
  a myotomy, achieved by thoracoscopic approach in prone position, was performed.

 

Follow-up: Six months later, the patient eats normally, with no pain, and is gaining weight.

 

Discussion points: the difficult problems of diagnostic and therapeutic approach regarding atypical dysphagia.

• Pre-treatment imaging and endoscopic workup and its interpretation,
• Choice of management (endoscopic or surgical approach),
• Long-term results.

 

​Discussion led by Brice Gayet and Stéphane Bonnet, IMM, Paris

with a top level panel currently being assembled.

 

Panel for discussion:

• Robert Bechara, Kingston, Canada
• Stefan Mönig, Geneva, Switzerland
• Marcelo Vela, Mayo Clinic, Scottsdale, AZ, USA
• Bruno Zilberstein, Sao Paulo, Brazil

 

Registration is free, but mandatory.

 

​Free registration

 

 

The next 10th Clinical case coming up for discussion on May 2021 will be proposed by
Prof. Luigi Bonavina from Milan.

 

Details and time will be announced on the OESO website and in the next Newsletter.

__________________________________________________

 

8th meeting:

from the University of Stanford

Hosted by by George Triadafilopoulos and John O. Clarke

Friday, March 19, 2021

• Stanford, USA (7:00-9:00 am West Coast PST)
• Europe: 3:00-5:00 pm
• North America: East Coast
• South America: Sao Paulo
• Asia: Beijing 10:00-12:00 pm
• Africa: Bomet, Kenya
• Australia: Melbourne

 

• Zoom technology applied
  
  

​

Presentation of the case:

• Patricia Garcia (Stanford GI Division)
• Dan Azagury (Stanford Surgery Division)

 

An obese patient being considered for bariatric surgery and also for future kidney transplant.

EGJ outflow obstruction on manometry and abnormal acid exposure on pH testing.

Concerns on Transplant/Bariatric surgery.

 

Discussion led by George Triadafilopoulos and John O. Clarke

with a top level panel currently being assembled.

 

Discussion points:

• Pre-operative physiology testing in bariatric surgery,
• manometric significance of EGJ outflow obstruction.
• The new Chicago classification for manometry, Version 4.
• Reflux & bariatric surgical selection.

 

Registration is free, but mandatory.

 

 

The next 9th Clinical case coming up for discussion on Thursday, April 15, 2021
will be proposed by Prof. Stéphane Bonnet & Brice Gayet, IMM (Institut Mutualiste Montsouris), Paris.

Details and time will be announced on the OESO website and in the next Newsletter.

As of now, you can begin to prepare your own contribution to this interaction,
your thoughts, your questions, and the areas of your experience that need to be better defined.

 

 

Robert Giuli, MD, FACS

Professor of Surgery

Founder & Deputy Executive Director of OESO

 

__________________________________________________

7th meeting:

from the University of Bordeaux, France

Hosted by Prof. Denis Collet

Hôpital HAUT-LEVEQUE, Pessac, France

Thursday, February 25, 2021

• Europe (Bordeaux 5:00 – 7:00 pm CET)
• Africa: Kenya +2h
• North America: West Coast -9h / East Coast -6h
• South America: Sao Paulo -4h
• Asia: Beijing +7h
• Australia: Melbourne +10h

 

• Zoom technology applied
  
  

Gist of the Case:

Presentation of the case: Prof. Caroline Gronnier

 

A 61 year old male is addressed for a malignant tumour of the EG junction diagnosed during the follow up of a Barrett’s esophagus.

 

• Mild dysphagia with initial weight loss of 6 Kg, dropped from 94 to 88 Kg.
• Pre-therapeutic workup showing an adenocarcinoma with signet cells extending from the distal third of the esophagus to the upper part of the small curvature (cT3N+M0).
• Pre-operative chemotherapy using the FLOT protocol (4 cycles),
• Total eso-gastrectomy and coloplasty on June 17.

 

Patient discharged on July 4 after uneventful postoperative course.

Final pathology demonstrated a ypT4aN3R0 adenocarcinoma.

Panel of experts for discussion:

Surgery:

• Prof. Stéphane Bonnet (Pilot Center/Paris)
• Prof. Stefan Mönig (Pilot Center/Geneva)
  
  

Pathology:

• Ass. Prof. Maria Westerhoff – University of Michigan – University Hospitals

 

This case is the opportunity to discuss several problems which are not been resolved so far, concerning the particular cases of adenocarcinomas of the EG junction with signet cells:

• Is preoperative chemotherapy useful, as for the other types of adenocarcinomas?
• How extensive should the resection be, considering the risk of R1 in case of limited resection?
• What are the advantages and disadvantages of coloplasty as a substitute for the esophagus?

These points will be exposed and discussed with a selected panel of the experts.

 

Registration is free, but mandatory.

__________________________________________________

6th meeting:

from Melbourne, Australia

Hosted by Matthew Read, MD, PhD, MBBS, FRACS

Senior Lecturer, St Vincent’s Hospital, Melbourne

Friday, January 29, 2021

• Africa (Kenya, 10:00 – 12:00 pm)
• North America (El Paso, TX, 1:00 – 3:00 pm)

• South America (Santiago, 5:00 – 7:00 pm)
• Europe (Paris, 9:00 – 11:00 pm)

 

Zoom technology applied

 

Gist of the Case:

Recurrent hiatal hernia – Gastric volvulus – Gastroparesis

 

Presentation of the case: Dr Henry Badgery

A 67 year old lady with an acute gastric volvulus in the setting of a recurrent hiatus hernia.

 

• The patient had a hiatus hernia repair in a regional country hospital.
• Represented one year later with hernia recurrence and gastric volvulus.
• Transferred to Metropolitan Hospital (St Vincent’s Hospital, Melbourne) for ongoing management.
  – Underwent endoscopic decompression and subsequent revisional hiatus hernia repair with 180˚ posterior fundoplication.
  Recovered well.
• Multiple ED presentations over ensuing months with non-specific gastrointestinal symptoms.
  Gastric emptying and gastroscopy suggestive of gastroparesis.
• Successfully managed with Botox injection to pylorus.
  
  

 

Panel of experts for discussion:

Surgery: Professor Lee L. Swanström, Scientific Director – I.H.U. – Strasbourg

Gastroenterology:

• Professor Richard W. McCallum, Texas Tech University Health Sciences – El Paso
• Dr Chamara Basnayake, St’s Vincent Hospital – Melbourne
• Professor Hiroshi Mashimo, Harvard Medical School

 

 

Discussion points:

• Surgical management of recurrent hiatus hernia.
• Active management of gastric volvulus,
• Investigation and management of gastroparesis following revisional hiatal hernia surgery.

Registration is free, but mandatory.

 

__________________________________________________

 

6th meeting:

from Melbourne, Australia

Hosted by Matthew Read, MD, PhD, MBBS, FRACS

Senior Lecturer, St Vincent’s Hospital, Melbourne

Friday, January 29, 2021

• Africa (Kenya, 10:00 – 12:00 pm)
• North America (El Paso, TX, 1:00 – 3:00 pm)

• South America (Santiago, 5:00 – 7:00 pm)
• Europe (Paris, 9:00 – 11:00 pm)

Saturday, January 30, 2021

• Asia (Beijing, 4:00 – 6:00 am)
• Australia (Melbourne 7:00 – 9:00 am)

 

Zoom technology applied

Gist of the Case:

Recurrent hiatal hernia – Gastric volvulus – Gastroparesis

 

Presentation of the case: Dr Henry Badgery

A 67 year old lady with an acute gastric volvulus in the setting of a recurrent hiatus hernia.

 

• The patient had a hiatus hernia repair in a regional country hospital.
• Represented one year later with hernia recurrence and gastric volvulus.
• Transferred to Metropolitan Hospital (St Vincent’s Hospital, Melbourne) for ongoing management.
  – Underwent endoscopic decompression and subsequent revisional hiatus hernia repair with 180˚ posterior fundoplication.
  Recovered well.
• Multiple ED presentations over ensuing months with non-specific gastrointestinal symptoms.
  Gastric emptying and gastroscopy suggestive of gastroparesis.
• Successfully managed with Botox injection to pylorus.
  
  

 

Panel of experts for discussion:

Surgery: Professor Lee L. Swanström, Scientific Director – I.H.U. – Strasbourg

Gastroenterology:

• Professor Richard W. McCallum, Texas Tech University Health Sciences – El Paso
• Dr Chamara Basnayake, St’s Vincent Hospital – Melbourne
• Professor Hiroshi Mashimo, Harvard Medical School

 

 

Discussion points:

• Surgical management of recurrent hiatus hernia.
• Active management of gastric volvulus,
• Investigation and management of gastroparesis following revisional hiatal hernia surgery.

Registration is free, but mandatory.

 

 

__________________________________________________

 

• 5th meeting: Thursday, December 10, 2020
• Time: 4:00 – 5:30 pm Geneva time (GMT+2)
• Zoom technology applied
• Zones in a comfortable time to connect to the meeting: 
  Africa – South America – North America – Europe

 

Hosted by Stefan Mönig and Minoa Jung (Geneva Pilot Center)

 

2 cases will be discussed:

Gist of the 1st Case:

 

Esophageal gastrointestinal stromal tumors –
A surgical treatment guide.

 

Presentation of the case: Mirza Muradbegovic

Moderator: Peter Grimminger

A 73 year old female patient with a giant gastrointestinal stromal tumor (GIST) of the distal esophagus.

• Two-month dysphagia associated with spasm. Absence of symptoms of gastro-esophageal reflux.
• Upper gastrointestinal endoscopy with ultrasound and fine needle biopsies: submucosal tumor corresponding immunohistochemically to GIST.
• Thoraco-abdominal computed tomography and positron emission tomography confirmed the esophageal tumor size of 7cm.

 

Surgical treatment decided at Board meeting:

• Subtotal Ivor Lewis hybrid esophagectomy (laparoscopy and right-side thoracotomy) with intrathoracic end-to-side circular eso-gastric anastomosis.

 

Uneventful postoperative period was uneventful. Patient discharged/10 days.

Histopathology findings were pT3 N0 L0 V0 PN0 RO low-grade distal esophageal wall GIST 6.5 cm, with low mitotic activity (MA) and no mutations of c-KIT and PDGFRA.

 

Clinical, radiological, and endoscopic patient follow-up.

Total recovery 15 months after esophagectomy without signs of oncological recurrence or functional disorders.

 

Panel of experts for discussion:

Surgery: Olivier Huber – Minoa Jung – Stefan Mönig – Beat Müller – Ralph Peterli – Johannes Zacherl

Oncology/Gastroenterology: Markus Möhler

Pathology: Rupert Langer

 

Discussion points:

• With endoscopic/echographic diagnosis of esophageal submucosal tumor of the esophagus would you recommend a biopsy?
• What additional investigations are necessary (CT scan, PET)?
• In which cases is neoadjuvant treatment recommended?
• What would your surgical strategy be for esophageal GIST? Do you propose radical esophagectomy for all cases? What are the alternative surgical options?
• Is systematic lymph node dissection mandatory?

 

 

Gist of the 2nd Case:

 

Patient with severe obesity, gastroesophageal reflux, and gastric metaplasia.
Which operation to offer?

 

Presentation of the case: Minoa Jung

Moderator: Ralph Peterli

 

Barrett esophagus and reflux-esophagitis 5 years after laparoscopic sleeve gastrectomy
and Roux-Y-gastric bypass

 

A 48-year-old male patient of Spanish origin with BMI 38.4 kg/m2, metabolic syndrome, obstructive sleep apnea, depression, and gastroesophageal reflux.

• Esophagogastroscopy (2016): hiatal hernia with gastritis.
  Helicobacter pylori infection eradicated at that time.

 

Consultation at a private practice center specialized in bariatric surgery to discuss options for surgery.

• Gastroscopy: 10-mm Paris Is superficial lesion of the esophagus above the Z-line and 15-mm Paris IIa–IIb lesion at the incisura angularis.
• Biopsies of the incisura: intestinal metaplasia without helicobacter pylori.
• Endoscopic submucosal dissection (ESD) of gastric metaplasia performed at the private center.
• ESD confirmed a moderate intestinal metaplasia with low-grade atrophic gastritis (OLGIM 2, OLGA 1) at the antrum level.

 

Consultation at the University Hospital for a second opinion on the most appropriate bariatric surgery option.

 

Panel of experts for discussion:

Surgery: Peter Grimminger – Olivier Huber – Minoa Jung – Stefan Mönig – Beat Müller –
Johannes Zacherl

Oncology/Gastroenterology: Markus Möhler

Pathology: Rupert Langer

 

Discussion points:

• Are two lesions with moderate-grade gastric metaplasia (at the level of the incisura angularis and at the level of the distal antrum lesser curvature) considered as risk factors for gastric cancer?
• Which bariatric operation to offer?

             – Sleeve gastrectomy

               – Roux-en-Y gastric bypass

               – Roux-en-Y gastric bypass with removal of the excluded stomach

Registration is free, but mandatory.

__________________________________________________

 

• 4th meeting: Thursday, October 29, 2020
• Time: 5:00 – 7:00 pm Beijing time (9:00 – 11:00 am GMT)
• Zoom technology applied
• Zones in a comfortable time to connect to the meeting: 
  Africa – South America – North America – Asia – Australia – Europe

 

Hosted by Jie He and Yousheng Mao

China National Cancer Center

Cancer Hospital, Chinese Academy of Medical Sciences

 

Multidisciplinary Panels for the discussions:

China: Zhentao Yu (Shenzen) – Yongtao Han (Chengdu) – Keneng Chen (Beijing) – Junfeng Liu (Shijiazhuang) –
Qi Xue (Beijing) – Yin Li (Beijing) – Lijie Tan (Shanghai) – Chun Chen (Fuzhou) – Hecheng Li (Shanghai) –
Xiangning Fu (Wuhan) – Zhigang Li (Shanghai) – Shun Xu (Shenyang) – Yong Li (Beijing) – Jianjun Qin (Beijing) –
Hon Yang (Guangzhou) – Zhen Wang (Beijing) – Xuefeng Leng (Chengdu) – Jiagen Li (Beijing)

USA: Andrew Chang (Ann Arbor)      Kenya: Russell White (Bomet)      Switzerland: Stefan Mönig (Geneva)      Germany: Thorsten Götze (Frankfurt)      France: Stephane Bonnet (Paris)

 

2 cases will be discussed:

Gist of the 1stCase:

• A locally advanced esophageal middle thoracic squamous cell carcinoma with metastatic lymph nodes in the right recurrent nerve area.
• cT3N1M0 Stage III AJCC.
• 4 cycles of neoadjuvant immunotherapy combined with chemotherapy applied.
  No adverse events.
• Minimally invasive McKeown esophagectomy with two-field lymphadenomectomy 4 weeks after neoadjuvant therapy.
• Final pathological diagnosis: ypT0N0M0
  
  

Discussion points, with the panel of experts:

• Value of additional PD-1 blockade
• Neoadjuvant therapy
• Combined immunotherapy
• Evaluation of clinical response to treatment
• Indications for surgery in patients with clinically complete response

 

Gist of the 2nd Case:

• A potentially resectable locally advanced middle thoracic squamous cell carcinoma
• cT3N1M0 Stage III AJCC.
• Neoadjuvant chemoradiotherapy (2 cycles + 40 Gy).

• Poor response with tumor progression.

• Sequential chemotherapy combined with immunotherapy

• Significant response

• Minimally invasive esophagectomy 4 weeks after, with radical tumor resection.
• Final pathological diagnosis: ypT1bN0M0
• Sudden death of unknown cause.

 

Discussion points, with the panel of experts:

• Neoadjuvant therapy for locally advanced tumors
• Strategy for patients with poor response to chemoradiotherapy
• Indications for combined immunotherapy
• Indications for surgery in such patients
• Preferable surgical techniques after complex neoadjuvant therapy
  
  
  

Registration is free, but mandatory.

 

____________________________________________________________

• 3rd meeting: Saturday, October 3, 2020

 

Hosted by Russel White and Michael Mwachiro

From Tenwek Hospital (Bomet, Kenya)

 

Multidisciplinary Panel for discussion:

Matthew Read (Melbourne) – Kumwinder Dua (Milwaukee) 

• Time: 7-9 am EAT (East African Time, GMT+3)

• Zoom technology applied
• Zones in a comfortable time to connect to the meeting:

 

Gist of the Case:

An unusual case of a 6 year old female involving a foreign body lodged in the esophagus for an extended period of time. The case required a multidisciplinary approach between surgeons and endoscopists to provide appropriate initial care for the patient, and for the complications which arose.

 

The patient complained of a persistent cough of at least three months duration. She had a chest radiograph performed which revealed the presence of a foreign body in the oesophagus at the level of the tracheal carina. Neither she nor her mother recalled the incident of ingesting the foreign body. The child was able to tolerate a normal diet without difficulty. She did not appear to be in any significant distress, but did have a persistent cough.

 

Upper GI endoscopy revealed a metallic foreign body, firmly wedged in the mid-esophagus. There appeared also to be a trachea-esophageal fistula present in the anterior surface of the esophagus.

 

Discussion points, with a panel of experts:

• What would you do with this patient?
• What would be your therapeutic strategy?
• How would you proceed surgically?

 

____________________________________________________________

 

• 2nd meeting: Wednesday, July 22, 2020

      Time: 7-9 am PDT (10 am-12 pm EDT / 4-6 pm CEST / 5-7 pm EAT / 10-12 pm CST)

 

 From Stanford, USA

 • Hosted by John Clarke, George Triadafilopoulos and Dan Azagury

 • Junior Faculty: Micaela Esquivel, Afrin Kamal and Thomas Zikos

Gist of the Case:

A challenging case of achalasia in the context of hypersensitivity and other comorbidities, with dilemmas in treatment and complications thereafter.

One of the most challenging cases of achalasia management that we have seen at Stanford and sure to stimulate conversation.

 

Discussion points, with a panel of experts

 • Physiology of achalasia

 • How to choose the initial line of therapy

 • Complications after surgical intervention

 • Treatment of reflux after achalasia therapy

 • When to consider esophagectomy0

 • Treatment of belching

 • Next steps

 

 • Zoom technology applied

 • Centers in a comfortable time zone to connect to the meeting:
   North America – South America – Europe – East and South Africa – Asia

____________________________________________________________

• Inaugural meeting: Thursday May 28, 2020

      From Milan, Italy, by Professor Luigi Bonavina – Ass. Prof. Emanuele Asti

      From Stanford University, Invited Expert: Professor George Triadafilopoulos

      Patient case: a long history of GERD – Association of a giant hiatal hernia ​

 

This first concrete achievement of our new virtual project was unanimously applauded.