Fall 2015  
  • DDF, a triennial multidisciplinary meeting with more than 4,500 participants over four days.
  • NHS Imperial Biomedical Research Centre's simulation vascular lab. The center is fully equipped to allow teams to train in perioperative scenarios to improve team dynamics and emergency readiness.


Traveling Fellow: Reflections on the ACPGBI Annual Meeting

By Sharon Stein, MD

Dr. Sharon SteinI was honored to be selected as the 2015 ASCRS Traveling Fellow, an award offered by the ASCRS and the Association of Coloproctology of Great Britain and Ireland (ACPGBI). It provides funding for one of ASCRS’s junior members to attend the ACPGBI annual meeting as well as visit sites around Great Britain and Ireland. For me, this was a unique opportunity to take some time to think, learn, and explore different ways to treat colorectal disorders.

Week 1: Digestive Disorder Federation Meeting, London
The first week of my fellowship was spent at the Digestive Disorders Federation (DDF) Meeting in London. This collaborative meeting of ACPGBI, Association of Upper Gastrointestinal Surgeons, British Association for Parenteral and Enteral Nutrition, British Association for the Study of the Liver, and British Society of Gastroenterology is very similar to our Digestive Disease Week (DDW).

As with DDW, the collaboration by multiple specialties was great for expanding my horizon and adapting tricks used by gastroenterologist and upper GI surgeons to colorectal problems. There were terrific multidisciplinary sessions on difficulty polyps, radiation proctopathy and treatment of intestinal failure. Particularly exciting were novel techniques such as a device to assess patients’ IV fluid intake at home, so that intestinal failure patients could be assessed remotely. A dynamic session by Ben Goldacre, champion of ALL Trials, discussed truth in trial reporting.

The ACPGBI council was amazingly hospitable, from a welcome dinner overlooking the Thames, complete with fireworks, to a wonderful night of music at the conference. I would like to thank ACPGBI President Aisha Senapati, Steve Brown, and Ann O’Mara for making me feel so welcome. Throughout the week I was struck by differences between practice in the United States and United Kingdom, including use of colonoscopy versus CT colonography for evaluation of synchronous colon lesions and the limited use of radiation for rectal cancers.

The ACPGBI sessions were excellent – especially the preview of then-unpublished trials on lap lavage, transanal resection versus radiotherapy for early rectal cancer, and Hartmann’s versus intersphincteric resections for patients not eligible for reconstruction. I sat in on the ACPGBI discussion of surgeon-specific reporting in 10 specialties and focusing on 90-day oncologic outcomes in colorectal surgery – likely a preview of the future for US surgeon reporting.

Week 2: St. Mary’s-Imperial College, Westminster
Following DDF, I was able to spend time at two storied institutions, St. Mary’s/Imperial College and St. Mark’s. At St. Mary’s, Paul Ziprin was a wonderful host. I spent time in theatre, on rounds, and in a wonderful multidisciplinary conference. Imperial has a rich research collaborative structured so that surgeon trainees are physically and intellectually paired with engineers and scientists to stimulate collaborative thinking. I toured research labs where innovative young surgeons are working on creating a CT-guided robot and 3-D reconstructions and a wonderful vascular lab used for team simulation training.

Week 2: St. Mark’s, Westminster
Omar Faiz was an equally welcoming host at St. Mark’s. The greatest challenge was trying to fit in time to see all of the cases. While Dr. Faiz discussed changes in the treatment of FAP patients (less pouches and ileosigmoid anastomoses), Sue Clark provided pouch pearls and Janindra Warusavitarne and Brian Saunders introduced me to their combined Endoscopic–TAMIS (TASER) technique for difficult rectal polyps. Ian Jenkins inspired me with a meticulous reoperative rectal cancer case. Professor Kennedy demonstrated his technique for colonic sentinel lymph node identification. And who can resist a personal lesson on fistulas from Professor Phillips? I was able to visit the intestinal failure unit and learn pearls on treatment of patients with short gut. The wonderful international and national fellows at St. Mark’s were generous with their time, knowledge, and hospitality.

Final reflections
Over the course of my time, I was struck by differences between US and UK practices. While no system is perfect, the National Health Service places a welcome emphasis on providing practitioners with time for continuing medical education, resident education, and administrative work. However, I also met many great junior doctors who are still looking for permanent positions, well after we would have completed training in the United States. These issues are particularly relevant in light of the recent junior doctor contract negotiations.

I am grateful to ASCRS and ACPGBI for this wonderful opportunity to spend time immersed in colon and rectal surgery. I came back with new enthusiasm for clinical practice and research, as well as a few new friends and colleagues.

 
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