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Irish Society of Gastroenterology Summer Meeting, virtual, 18 June 2021
The 2021 Irish Society of Gastroenterology (ISG) Summer Meeting was held virtually on 18 June, and featured a stellar line up of internationally renowned speakers from the US, Portugal, UK, and Ireland. Key themes included lower GI issues such as how to use faecal immunochemical testing (FIT) for symptomatic patients, plus managing gastrointestinal consequences of pelvic radiation disease. In the area of liver disease there was an expert update on evidence-based management of ascites, while upper gastrointestinal themes covered included endoscopic treatment of preneoplastic and early cancers and an update on what is new in surgery for gastric cancer.
One of the most common presentations in gastroenterology, irritable bowel syndrome (IBS) was also covered, as well as the prevention of post- operative Crohn’s, while the latest knowledge in haemochromatosis was also shared.
This meeting was the last as ISG President for Dr Tony Tham, Consultant Physician and Gastroenterologist, Ulster Hospital, Belfast.
“I wish to thank you and the Society for giving me the honour and privilege to be your President for the last two years,” he said.
“It has truly been the highlight of my career. “I would also like to thank our industry colleagues and friends who have continued to support us during the pandemic. Without them, it would not be possible to hold this meeting. I would like to thank the outstanding effort of our Chief Executive, Michael Dineen and also Cora Gannon for organising this meeting. I would like to thank the ISG Board for their support and guidance as always and Dr Garrett Cullen and our co-chairs.
“It has been a most challenging time with the pandemic but what we as a Society have learned is to be able to adapt to changes. I look back with pride with what the Society has achieved over the past two years with the ‘E’s: Engaging with other societies and clinical services; collaborating with Europe, and Educating our members.”
At the close of the meeting, Dr Tham handed over the chains of office to incoming ISG President Prof Deirdre McNamara, Associate Professor of Gastroenterology, Trinity College Dublin, and Consultant Gastroenterologist, Tallaght University Hospital.
Managing ascites in cirrhosis
The choice of treatment for ascites in cirrhosis should be primarily guided by what helps patients feel and function better, and survive longer, Prof Guru Aithal, Professor of Hepatology and Head of Division for Digestive Diseases, University of Nottingham, UK, told the 2021 ISG Summer Meeting. Prof Aithal was the lead author of the recent guidelines on the management of ascites in cirrhosis produced by the British Society of Gastroenterology in collaboration with the British Association for the Study of the Liver.
Over the years, there has been a substantial improvement in care and survival of patients with liver cirrhosis, including those with ascites, despite higher age and more medically complex disease. Addressing ISG delegates, Prof Aithal said the timely diagnosis of spontaneous bacterial peritonitis, which has a prevalence of 1.5-to-3.5 per cent in outpatients and up to 11 per cent in inpatients, is key, as one study has shown that each hour of delay in diagnostic paracentesis is associated with a 3.3 per cent increase in in-hospital mortality adjusting for MELD score.
The use of human albumin solution (HAS) has long been the standard treatment in large volume paracentesis (LVP), with robust data now on its effectiveness, he noted. A meta-analysis of 16 studies has shown that compared to other alternatives (including vasoconstrictors), the use of HAS has led to 57-100 fewer patients dying per 1,000 paracentesis.
Transjugular intrahepatic portosystemic shunt (TIPS) is an alternative to paracentesis, for refractory ascites, and also has good quality data supporting its effectiveness; with the now standard use of polytetrafluoroethylene (PTFE)-covered stents seeing a long-term patency at one year of 92 per cent, and 89 per cent at two years.
While it has good outcomes and mortality data for patients on transplant lists, “careful patient selection is critical”, cautioned Prof Aithal. Data also supports TIPS as being more cost-effective and scoring higher on QALY than LVP, he added.
The Alfa pump, a subcutaneously-implanted device that pumps ascitic fluid from the peritoneal cavity into the bladder, is another option for refractory ascites. Studies have shown good results, with improvement in quality-of-life. However, it is expensive and requires surgical skill, as well as being associated with acute kidney injury in some patients, Prof Aithal said.
Long-term abdominal drainage is another option to palliate ascites, for those who are unsuitable for transplantation and wish to stay at home, with data showing reduced need for paracentesis and hospitalisation, he concluded.