2018 42nd New York Annual Course Success!

 

2019NYCnewyears

First, and this is a big one, we had outstanding registration, totaling close to 700 for the main sessions!!  We had a delegation of 15 physicians attend from China.

 We also had over 200 Workshop and Symposia registrants, at last count. This remains the largest regional GI meeting in the USA each year, and trails behind only DDW and the ACG meeting in terms of attendance.

We had 89 faculty, 41 presentations in the main session, 24 presentations in the Nurses and Associates program, and countless others in the satellite seminars.

In fact, there were 5 separate satellite and hands-on sessions during the Course, and several other special Programs. These sessions are each unique, innovative and in a word, outstanding.

We had attendees from all over the US and around the world, a testimony to the far reaching word of mouth “buzz” there is about this Course each year.

On top of all that, we had seven innovative lunchtime symposia, and 11 special lectures, including the Florence Lefcourt Lecture, given by Tonya Kaltenbach, the David Falkenstein Lecture, given by Todd Baron, the Ed Bini Lecture, given by Larry Brandt, the ASGE President’s Lecture by Steve Edmundowicz, the NYSGE President’s Address by Seth Gross, the Richard McCray Lecture, given by Sid Winawer, and the Peter Steven’s lecture, given by Stavros Stavropoulos.

We had an incredible scientific poster session, led by Susana Gonzalez and Lauren Khanna. This year we had over 50 different authors who submitted 38 posters, with several entries from outside the NYC area!!  The poster session review included a cocktail reception on Thursday evening. The room was packed; this is indeed a popular event!  The always popular Peter Steven’s Video Forum, led by Anthony Starpoli and Juan Carlos Bucobo, again was a huge success, with 6 outstanding videos, including one submitted from Canada.  The Fellow’s Forum on Thursday evening was superb, coordinated by Michelle Kim and Brian Bosworth; the feedback was excellent.

 The Doris C. Barnie Nurses and Associates Program, skillfully arranged as always by Barbara Zuccala and Nancy Schlossberg, again was a huge success, with outstanding lectures and interactive sessions. The Nurses and Associates program this year attracted well over 200 participants, all of whom were raving about the quality of the program. A huge thank you to Barbara and Nancy; we appreciate their efforts immensely.

The Live from New York Course was packed with a range of incredible cases again this year…our most sincere gratitude to Greg Haber for the unbelievable amount of energy and effort he puts into directing this truly outstanding piece of the Course each and every year.  Big time thanks to Sammy Ho as well for his co-leadership this year.   The NYU-Langone location continues to be excellent.  Many thanks to the team there who worked hard to coordinate everything. The quality of the HD transmission is truly spectacular; even more impressive is the quality of the material being presented and the quality of the Faculty doing the procedures and commenting on the care…fascinating procedures at the cutting edge of gastroenterology explained by masters in their field!!  

Gratitude is well-deserved to the many persons who give their time to the New York Course.

Thanks to our out of town guests at NYU, Todd Baron, Guido Costamagna, Jacques Deviere and Vanessa Shami, who were simply amazing, as well as to our NYC Faculty, who were equally awesome!

Thanks as well to all the panelists at the Marriott, who really were very lively and provocative this year, many of whom spent parts of both days with us…the panel discussions really brought out critical decision making points in each case…many thanks!!

 Also, we can’t thank David Robbins enough.  David is now the master of the hugely important role of being behind the scenes at the live course…really making it all happen, but rarely seen!!  We couldn’t have done it without him!!

Phil Joseph and his team at Advance Concepts get big time kudos as well.  Their audiovisual and technical expertise is beyond amazing and we appreciate their help greatly!!

Also thanks to the NYU staff (there are many, many people involved there)!!

 The Satellite Courses, both hand-on and didactic, continue to be a huge draw. Small groups, great teaching…what more could you ask for??  Nearly every session was filled to capacity, a fairly amazing thing when you consider all that is going on and the proximity of the meeting to the Holidays. The directors of each satellite session are truly responsible for the success of each individual program, and so we want to thank those individuals specifically:  Frank Kasmin, Nikhil Kumta, Ira Jacobson, Joesph Odin, Reem Sharaiha, Violeta Popov, Sammy Ho, Frank Gress, Amrita Sethi, and Arvind Trindade; all did an amazing job!!

 We also ran the Annual New York GI Fellows Endoscopy Course on Wednesday.  It was a full day Program for 36 GI Fellows in training, and featured a full range of lectures and hands-on training, with 12 specific hands-on stations for luminal and pancreaticobiliary teaching.  Amazing.  Thanks to the group that led that effort this year, Chris DiMaio, Adam Goodman, Reem Sharaiha and Stavros Stavropoulos. 

 A special enormous thank you to Karen Cervenka, the Society’s Managing Director, for being so incredible.  Karen works seemingly endlessly (and then more!) to put every aspect of this very complicated Course together, and she once again did a simply phenomenal job.  Her enthusiasm, energy and dedication are very much appreciated!!!!  Many others at Digestive Health Works also worked very hard on our behalf…thanks to Bina Mesheimer, Robin Weidy, Barbara Connell and everyone else who contributed behind the scenes. 

 Thanks also to Montefiore CME, and in particular Nada Piacentino, Marilyn Sasso and Vic Hatcher for their help. Nada retired earlier this month, and we thank her as well for all her years of dedication to NYSGE and our Programs.

 We still miss Florence Lefcourt, the “heart and the soul of the Society”, but she “continues to be there” as well. Regular tributes to her remind us all of the wonderful woman who led us for so many years!!

The NYSGE Council helped whip the Program into shape many months ago, and we appreciate their efforts as well.  Today’s version of the Course is really built on the Courses of 20, 30 and now over 40 years ago…we thank the many NYSGE council members over all the years, as well as the original founders of the Society, and appreciate all they did to shape the Society and to shape this Course. Also, congratulations to the Society’s current President, Seth Gross, who has had a most successful year as President!!

Most of all, we want to thank you, the Faculty of this year’s Course. You took time away from your busy schedules to join us, traveling from far and wide (Belgium, Italy and every corner of the US), worked really hard on syllabus contributions and high quality presentations packed with videos, photos and cutting edge information.  We know how difficult that can be, and just want to express our sincere gratitude for all that each of you did. The spirit of collegiality is so readily apparent; we all work together really well, and that is terrific.  One more truly important thing…we all seemed to have loads of fun, and that’s maybe the best marker that things continue to go so well!! 

Yes, the 42nd Annual NYSGE Course was indeed a special one, and so thanks one more time for being part of it.   Our best wishes for a wonderful Holiday season and a Happy and Healthy New Year from all of us to all of you!!

 

Dave

Patrick

Tamas

Barbara

Nancy

Greg

Sammy

Adam

Karen

Controversies in GERD Management

Gastroesophageal reflux disease, or GERD, is defined by the Montreal Classification as “a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications.” This characterization has always been intentionally broad, as symptoms of GERD can vary widely in patients, and the frequency of symptoms does not necessarily correlate with the quantity of reflux in an individual patient. To further complicate matters, only certain patients have long-term esophageal injury from GERD. Progression of GERD to Barrett’s esophagus and even esophageal adenocarcinoma can occur, but the majority of patients with GERD do not develop these long-term sequelae. In patients without concerning esophageal injury, and accumulating data on the potential risks of long-term proton pump inhibitor (PPI) therapy, how are we to think long-term about their reflux disease? If the symptoms are not able to be managed with dietary and lifestyle changes alone, should we now be considering alternative medical and procedural therapies in more of our patients?

To have a chance to answer these questions, I believe it is vital to step back and ask: why does my patient have GERD? Sometimes, the answer is obvious: it could be a recent dietary change or weight gain, or a clear anatomic process at the esophagogastric junction (EGJ) such as a hiatal hernia. However, if the cause is not obvious, further evaluation of the mechanisms of GERD in a patient can be important. The attention and interest in the pathophysiology of GERD has been increasing in recent years. For example:

-Without a hiatal hernia, traditionally it has been unclear whether a low pressure lower esophageal sphincter (LES) may have a role in contributing to worsening GERD. In addition, with the advent of high-resolution esophageal manometry studies, other LES metrics, one being the “EGJ contractility integral,” are being deciphered to study the EGJ comprehensively. Still other technology, with impedance planimetry, is being studied to assess the compliance of the LES in patients with GERD.  

-There is a body of literature suggesting that the LES may shorten over time, and this decreasing LES length may be a surrogate for progression of GERD. Here too, esophageal manometry may be beneficial in determining the primary underlying cause of GERD.

-Transient LES relaxations have been a known mechanism of GERD for many years. However, the majority of evidence suggests that the quantity of these relaxations may not be the most significant factor, and GERD patients instead will likely reflux more when the relaxations occur. Thus, the physiology of the proximal stomach may have a function in GERD, and indeed an “acid pocket” has been described at the EGJ from which reflux can originate after a meal. The location of this reservoir may vary amongst patients.

There are many potential mechanisms for GERD, and these are but a few that have received recent attention. Work to decipher the major etiologies of GERD in patients is encouraging, and eventually we can hope for different “phenotypes” of GERD patients based on mechanisms.

Importantly, we know that an overall balance of symptom triggers (causticity of gastric contents, volume of reflux) and symptom modulators (ability to clear reflux, tissue sensitivity) exist to create the condition of GERD. There are a variety of technologies now that attempt to quantify reflux in patients and correlate that reflux to particular symptoms (wireless pH as well as catheter-based pH and impedance-pH testing), and even focus on the chronicity of reflux in an individual patient (mucosal impedance testing). Further study of these technologies is expected to improve our categorization of GERD patients. Lastly, our options for treating GERD continue to widen, at the same time there is increasing physician and patient concern over long-term potential adverse consequences of PPIs. There are several modern procedural options for treating GERD, with both endoscopic and laparoscopic approaches emerging in recent years.

So how should I treat my patient with GERD on long-term PPI? My approach has always been: if there is no clear indication for indefinite PPI, the goal should be to decipher if there is a therapeutic option that will allow the patient to stop it. This may be a dietary, medical, endoscopic, or surgical approach. Thinking long-term about GERD coincides with considering its mechanisms. In the current landscape, a meticulous individualized approach to care, with a concise discussion on the risks and benefits of both medical and procedural therapies for GERD, is warranted.

As we improve our ability to categorize and “phenotype” patients with GERD, as well as use our motility, pH, and impedance technologies to assess GERD in individual patients, carefully done studies should allow us to develop appropriate diagnostic and treatment algorithms. Certainly, not every patient with GERD will be expected to improve with an LES augmentation procedure, but the goal will be to answer: which patients should get which procedure? As of now, we know that the patients that do best with LES surgery are also the patients who respond best to PPI. We have to do better than that. In the coming years, I expect that we will.

 

Abraham Khan, M.D.

Director, Center for Esophageal Disease

NYU Langone Medical Center