2018 42nd New York Annual Course Success!



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!!











Fecal Microbiota Transplantation: Beyond the treatment of Recurrent Clostridium Difficile

Do your patients ask you a lot of strange questions? Since I’ve begun doing fecal transplants (FMT), here are some of the typical questions I’ve been getting:

• “Is the FMT donor fat?”
• “Was the FMT donor breastfed?”
• “I have two great FMT donors and don’t want to hurt anybody’s feelings. Could you mix their stools?”
• “How do you extract the stool from the FMT donor?”
• “What if it doesn’t agree with my own poop?”

Image result for free fecal transplant image

Today, FMT has one approved use: the treatment of recurrent Clostridium Difficile colitis. For that use, the success rates are extremely high. Of all the things we prescribe as doctors, this is one we can feel unambiguously proud of. It’s fast, effective, and inexpensive. This is no small matter: about 30,000 Americans die every year of Clostridium Difficile . Millions of dollars are spent treating this infection, which can be devastating. One can administer FMT though the upper GI tract or directly into the colon. Since Clostridium Difficile colitis affects the colon, today most gastroenterologists administer it via colonoscopy.

As a result of this success, now some patients will try anything to convince you that they need a fecal transplant to cure a whole host of maladies. Others will refuse one even when they have been debilitated by years of infectious colitis and multiple hospital admissions.

But will there be other clinical uses for fecal transplant?

To do justice to this question, it is important first to consider the topic of the microbiome. Recently, FMT has inspired the medical community to look at this “newly discovered organ” we had been ignoring for so long. The “organ” is our microbiota: an enormous number of cells living in an organized dynamic ecosystem and playing so many roles in virtually every aspect of our health and disease. Our gut microbes interact with each other and with us, the host. We have coevolved and developed a mutually beneficial relationship: we provide them with food and shelter and they help with our nutrition, our ability to fight infections, our metabolism, and even our neurologic development. Their study is particularly fascinating because it brings together medicine, ecology, and evolution.

To better understand the microbiota, we have used several tools that have allowed us to gather an enormous amount of information: more information than we can actually interpret. In a sense one could say that technology is ahead of science. Today, for example, we have the ability to sequence the genetic material of the organisms that live in the gut instead of culturing them.

We have observed that the microbiota of patients with IBS, IBD, metabolic syndrome, obesity, autoimmune diseases, and even autism is different from the “normal” microbiome, but association and causation are of course two different things.

Moreover, it has become clear that in order to understand the effects of the microbiota, we need to not only identify these microorganisms, but also measure the products of their metabolism. The mere presence of a particular microbe or a group of microbes may not be as important as what they are doing.

FMT has also helped to advance our understanding of the microbiome and its role: If for example a disease or a trait can be transmitted though FMT, that could support at least some role of the microbiota in causing that disease or trait.

But studying the effects of stool transplant is a lot more complicated than studying the effects of a regular drug. Even though stool (when used for FMT) is now considered a drug, there are many unknowns: dose, ideal route of administration, mechanism of action, etc. Also, each individual person’s stool is different, like a fingerprint. And it may therefore interact in a unique way with the recipient’s microbiota.

A few months ago we started to enroll patients in a multicenter study with doctors at Montefiore, Yale, and Concorde Medical Group to investigate the possible use of FMT in IBS-D (diarrhea predominant IBS).

IBS-D, especially when it is moderate to severe, can be a debilitating disease and very frustrating to treat. Most patients have typically tried conventional therapies like special diets, probiotics, antidiarrheals, antispasmodics, and sometimes antibiotics like rifaximin, which was recently approved for this use.

Why are there currently so many different conventional therapies prescribed for IBS? Likely this is because the pathogenesis of IBS is so little understood. Visceral hypersensitivity, low-grade inflammation, and dysbiosis have been thought to play a role.  Regarding dysbiosis, we know that there is an abnormal microbiota: the numbers of lactobacilli and bifidobacteria, for example, are lower in patients who suffer from IBS than in those who don’t. Also their microbiota seems to be less diverse. Replacing “good bacteria” is the idea behind the use of probiotics, which seem to help some patients. But why are they not sufficient to cure IBS in most patients? The answer is not clear today. Perhaps the numbers of bacteria that survive the passage through the GI tract are not sufficient. Or maybe in order to change that whole ecosystem that is our microbiota in a permanent way, one has to modify it more radically instead of just adding a few specific strains of bacteria.

Despite the unanswered questions about IBS-D, we hypothesize that IBS-D is a condition that occurs secondary to an altered microbiota in the small bowel. Therefore, instead of administering the FMT via colonoscopy as we would do for recurrent Clostridium Difficile colitis, we are using “poop capsules.” It’s a 6-month, randomized, placebo-controlled trial and at 3 months there is a crossover so by the end of the study 100% of the patients will have received the active drug.

Image result for free fecal transplant image

As doctors and investigators, we are eager to help our patients with this very debilitating disease. In the process, we also hope to learn more about the microbiota, its effects on our health, and how this new knowledge will lead to exciting new therapies.

To learn more about this trial, go to clinicaltrials.gov

Caterina Oneto, M.D. (@caterina_oneto) | Twitter