Digestive Disease Week Covers Landscape of GI Disorders

Caroline Helwick

May 10, 2013

ORLANDO, Florida — The mystery of the gastrointestinal microbiome, next-generation colonoscopy screening approaches, new uses for older modalities, and much more will grab the attention of attendees at Digestive Disease Week (DDW) 2013.

Choosing from among the hundreds of sessions will be tough.

DDW 2013 is jointly sponsored by 4 societies: the American Gastroenterological Association (AGA); the American Association for the Study of Liver Diseases (AASLD); the American Society for Gastrointestinal Endoscopy (ASGE); and the Society for Surgery of the Alimentary Tract (SSAT).

The meeting is considered the largest and most prestigious in the world for the gastroenterology professional. This year, 15,000 international physicians, researchers, and academics will hear about advances in colorectal disease, hepatology, endoscopy, and gastrointestinal surgery, as well as advances in the prevention, diagnosis, and treatment of digestive disorders.

Dr. Richard Peek

On the basis of attendee feedback from previous meetings, the most exciting aspect of DDW also seems to be the most frustrating: overlap because of the depth and breadth of DDW. This will change a bit this year, making DDW easier to "take in," said AGA program chair Richard Peek, MD, professor of medicine and director of gastroenterology at Vanderbilt University in Nashville, Tennessee.

"This year, the AGA tried to respond to surveys from the past and make the meeting much more manageable and negotiable," he said. "The societies are partnering with each other to consolidate programming and reduce redundancy and duplication among sessions. A few years ago, we consolidated a 5-day meeting into 4 days; now we are further collapsing the complementary programs from the different societies so attendees will be able to traverse the meeting better."

For the first time, the ASGE and AGA will host a combined Presidential Plenary Session, which will include some of the most innovative research presented at DDW and 7 state-of-the-art lectures from international experts. Both societies have scheduled their postgraduate courses and other DDW programming around this collaborative session so that delegates can grab a seat without missing other educational opportunities, Dr. Peek explained.

In one of the most exciting presentations in the combined ASGE/AGA Plenary, a study by senior author Douglas Rex, MD, from the Indiana University School of Medicine in Indianapolis, and colleagues looks at the new FUSE endoscopy system, which provides twice the visibility of the colon as that provided by standard colonoscopy.

The AGA has recommended "tracks" for different constituencies within the society, and section counselors have made recommendations for sessions and abstracts of interest relevant to those tracks, he said.

"Again, we are trying to make the meeting as palatable as possible, as DDW can be overwhelming," he added.

Late-Breaking and Best Abstracts

On Tuesday, the late-breaking abstracts sessions will be divided into basic and clinical research, and will be even more "late-breaking" than usual. "We received some very high-quality submissions in each category," Dr. Peek said.

"Attendees should definitely stay for these, as well as for the Best of DDW session, in which each society will highlight a prominent theme and have experts comment on the findings and give a take-home message. This is a very useful summary of the meeting for people who don't have time to see it all," he explained.

Program chairs have created an itinerary that aims to "increase the contact time the attendees have with dedicated experts in specific fields," Dr. Peek told Medscape Medical News. On this itinerary are 12 poster tours.

Much In Store for Endoscopists

ASGE program chair Kenneth McQuaid, MD, said endoscopists have much to be excited about in this year's lineup. Dr. McQuaid is chief of gastroenterology at the Veterans Affairs Medical Center in San Francisco.

For attendees interested in endoscopic retrograde cholangiopancreatography (ERCP), the Topic Forum on evolving technologies and techniques will highlight new approaches and devices (abstracts 61, 62, 63, 64, 65, 66). "Since this field has been a bit stagnant for a while, this is exciting," Dr. McQuaid said.

One example of cutting-edge research, entitled Safety and Success of Direct Retrograde Cholangioscopy by Use of an Ultra-slim Endoscopy — Results of a Multicenter Study, will be presented by Harald Farnik, from the Department of Internal Medicine, Johann Wolfagang Goethe-University Hospital and Clinics, Frankfurt, Germany (abstract 62).

Another is the study entitled Final Results of a Prospective Bicentric Study Assessing Probe-Based Confocal Laser Endomicroscopy: Impact in the Management of Biliary Strictures, which will be presented by Marc Giovannini, MD, head of the endoscopy unit at the Paoli-Calmettes Institute in Marseilles, France (abstract 63).

A high-value Topic Forum on Tuesday will look at the prevention of pancreatitis, which occurs in up to 5% of patients undergoing ERCP. "There are 5 very good papers on this topic," he said (abstracts 1045, 1046, 1047, 1048, 1049). The state-of-the-art lecture, by Peter Cotton, MD, from the Medical University of South Carolina in Charleston, will explore ways to improve the safety and success of ERCP. It should be a highlight for ASGE members

The Topic Forum on Saturday that will address the quality of bowel preps and new ways of delivering them should be of interest to colonoscopists. Abstracts will describe ways to enhance patient compliance — one being a smartphone app (abstract 190) — and new preps that will hit the market soon, Dr. McQuaid explained (abstracts 189, 190, 191, 192, 193).

Barrett's Esophagus, Endoscopic Ultrasound, and Small Bowel

A Sunday morning Topic Forum on Barrett's esophagus will examine the role of radiofrequency ablation and endoscopic mucosal resection as they are performed around the world (abstracts 282, 283, 284, 285, 286).

Another Sunday morning Topic Forum will examine the role of endoscopic ultrasonography in guiding cancer therapy. "Endoscopic ultrasound has traditionally been a diagnostic modality, but it is now being used to render therapy," Dr. McQuaid noted. "The ability to address pancreatic tumors with this is very exciting" (abstracts 347, 348, 349, 350, 351).

Two abstracts are of particular interest in this forum: Role of Contrast-Enhanced Harmonic EUS in Differentiating Malignant from Benign Lymphadenopathy (abstract 348); and Phase I Trial of Endoscopic Ultrasound Guided Intratumoral Vaccination with Recombinant Panvac-F and Systemic Panvac-V in Patients with Locally Advanced Pancreatic Cancer (abstract 350).

"Pushing the envelope further," he said, another Sunday morning Topic Forum will feature 5 abstracts that will redefine the limits of endoscopic therapy, examining its use in the treatment of appendicitis and in bariatric surgery (abstracts 358, 359, 360, 361, 362).

For gastroenterologists interested in small bowel disease, a Monday afternoon Topic Forum promises to be stimulating. Investigators will report data on new technologies, such as magnetically guided and dissolving capsules. "This is where much of the development is happening now," he noted (abstracts 846, 847, 848, 849, 850, 851).

"In these and the many other Topic Forums presented at DDW, attendees will find a strong panel of original papers that will open their eyes to what is going on in the field," Dr. McQuaid told Medscape Medical News.

Role of the Gut Microbiome

DDW council chair Lawrence Friedman, MD, chair of medicine at the Newton-Wellesley Hospital in Massachusetts, said attendees will be brought up to date on new biologics for inflammatory bowel disease and emerging hepatitis C therapies. "Drug development is exploding in this area and the number of drugs coming down the pike is tremendous," he noted.

Personally, he is most interested in the intestinal microbiome and expects to hear fascinating new research in this area. "There will be a lot of information emerging about the role that bacteria play in health and disease, and how the manipulation of intestinal flora can affect health," Dr. Friedman said. "This is one of the biggest emerging areas of investigation in gastroenterology."