UEG Summer School 2023

Session descriptions
June 09-10, 2023 | Prague, Czech Republic

Bowel abdominal ultrasound in gastroenterology

Bowel ultrasound (US) is a cost-effective, non-invasive, and readily available tool for the
management of patients with inflammatory bowel disease (IBD) in clinical practice. Several
papers on the important role of bowel US in monitoring disease activity in IBD have been
published, showing this methodology to be both accurate and well-tolerated by patients.
Moreover, bowel US can be an effective tool for assessing patients with chronic
gastrointestinal disorders (e.g., abdominal pain and diarrhea) to ruling in and out a possible
organic cause. We are a group of gastroenterologists experienced in ultrasonography and
IBD.

The aim of this session of the UEG Summer School is to establish a starting education
programme for interested gastroenterologists to help make the knowledge of the use of this
method more widespread. In the first part of the session participants will learn about the use
of the different ultrasound probes, how to hold the probe, the basics of bowel ultrasound
anatomy, and get to know ultrasound images of the pathological bowel (e.g., IBD,
diverticular disease, appendicitis). In the second part of the session, every participant will
have the chance to perform a bowel ultrasound on healthy models to familiarise themselves
with normal bowel ultrasound.

Educational goals: After the course the participant should be aware of:
• The importance of use of ultrasound in the study of bowel diseases
• The indications for bowel ultrasound
• The limitations of bowel ultrasound
• How a correct bowel ultrasound is performed.

After the first approach in this session, bowel US will be less hostile for all participants. This
course could be the starting point for your ultrasound training!

Your faculty,
Hagar Banai
Clas-Göran af Björkesten
Andrea Costantino
Philipp Schreiner
Maria Luigia Vaiano

1
Capsule Endoscopy

This module provides an introduction to capsule endoscopy in clinical practice.

Each module consists of 2 hours. Delegates will be able to:
• Understand the clinical indications of capsule endoscopy.
• Use the Medtronic Pillcam software.
• Hand on experience to read and report capsule endoscopy videos encompassing a
range of small bowel pathology including.
− Small bowel bleeding
− Crohn’s disease,
− Coeliac disease
− Small bowel tumours

The module will end with an interactive friendly quiz to test your knowledge.

Your faculty,
Cristina Carretero
Reena Sidhu
Giorgos Tziatzis

Complications of portal hypertension: Practical approaches

The session “Complications of portal hypertension: Practical approaches” aims to elaborate

solutions to common clinical challenges in an interactive way. The emphasis will be put on
the implications of the recent Baveno VII Consensus for clinical practice. Moreover, the
session will touch upon porto-sinusoidal vascular disorder, a newly defined entity that may
lead to portal hypertension in the absence of cirrhosis.

Learning objectives (120 min, i.e., 4x 30 min)

• From non-invasive tests to non-selective betablockers for preventing complications
of portal hypertension (case).
• Management of variceal bleeding (case).
• Hands-on session on HVPG measurement and trans jugular liver biopsy.
• Hands-on session on TIPS placement.

Your faculty,
Minneke Coenraad
Virginia Hernandez
Mattias Mandorfer

2
Endoscopy I - Lower GI endoscopy (IBD endoscopy and polypectomy)

The Lower GI endoscopy session will provide “hands-on” practice on our “Endosim bovine
models” (guaranteed not to smell). The equipment you will use has kindly been provided by
Olympus.

The lower GI workshops will cover some common topics such as ‘’torque steering
techniques’’ and ‘’loop resolution’’ in colonoscopy as well as snare polypectomy for
beginners. The advanced trainees would have opportunity to perform EMR, apply endoloop
and endoclips, and have exposure to IBD endoscopy as well. If you are regularly practicing
endoscopic procedures these sessions will probably be too basic for you.

Endoscopy workshops proved to be most popular in the last years and we are looking
forward to having just as much fun this year.

Your faculty,
Jayan Mannath
Ruchit Sood
Radu Tutuian
Zuzana Vackova

Endoscopy II - Upper GI

The Upper GI endoscopy session will provide “hands-on” practice on our “Endosim Bovine
models” (guaranteed not to smell). The equipment you will use has kindly been provided by
Olympus.If you are regularly practicing endoscopic procedures these sessions will probably
be too basic for you.

In the Upper GI session ‘beginners’ are given the opportunity to understand/consolidate the
basics of intubation, identifying anatomy and biopsy techniques. There will be a brief
introduction to acute upper GI bleeding before swiftly moving on to “hands-on.” You will be
given the chance to practice basic haemostatic techniques including injection, heater probe
and the placement of through the scope clips which are commonly used for non varcieal
upper GI bleeding (NVUGIB). In addition to conventional haemostatic therapies, delegates
will have the opportunity to observe the set up and deployment of over the scope clips
(OTSC) for which there is increasing evidence for first line use in high risk bleeding lesions.
We have now incorporated an oesophageal varyx into our bleeding models so all
candidates will be able to familiarise themselves with variceal ligation device set up and
deployment. There will be a ELLA Danis stent station for demonstration purposes only as an
alternative option for variceal bleeding. Delegates will have an opportunity to view some
“real life” bleeding cases in any downtime.
Endoscopy workshops proved to be most popular in recent years and we are looking
forward to having just as much fun this year. We look forward to welcoming you to Prague in
June.

Your faculty:
John Jacob
Pradeep Mundre
Vita Skuja
Conchubhair Winters

3
Endoscopy III – Endoscopy with a colonoscopy simulator

This 2-hour training session will provide trainees with basic and advanced skills in
colonoscopy technique and allow them to practice colonoscopy on a silicone colon model.

The session will be structured as follows:

• 25' - Presentation of colon anatomy and colonoscopy technique, "tips and tricks",
ancillary maneuvers, video demonstration of resolution of loops. Each trainee will
be given a handout with detailed step-by-step instructions, including tips and
tricks and ancillary maneuvers, to perform a correct and successful colonoscopy,
from the simplest to the most complex.
• 5' - Trainees will be divided into three group (beginner, intermediate, or
advanced) based on the number of colonoscopies performed and each trainee's
experience. For each group, a presentation of the silicone model and
demonstration of a colonoscopy will be performed by a trainer.
• 90' - hands-on training session. It will be performed with the simulator under the
supervision of the trainer. Each novice trainee will perform a basic colonoscopy,
while each intermediate or advanced trainee will perform a more complex
colonoscopy with more difficult loops. Finally, the trainer will provide feedback to
each trainee, with suggestions to improve their colonoscopy skills.

Your faculty,
Jurjen Boonstra
Stavros Dimitriadis
Marco Napoli
Lucio Petruzziello

4
Endoscopy IV – Advanced endoscopy (Endoscopic ultrasound and ERCP)

The session on “Advanced endoscopy” will be aimed on educating attendees on EUS

examination technique including EUS-FNA, and ERCP technique, including cannulation,
sphincterotomy and stent placement. It will provide general information on main applications
for EUS and ERCP. Several EUS topics, including EUS anatomy, difference between radial
and linear EUS, T-staging of GI tumors, basics of pancreatobiliary and therapeutical EUS
will be briefly discussed. The participants will become aware of ERCP indications and
contraindications, several ERCP cannulation techniques and potential complications.
Moreover, the participants will have an opportunity to train the technique of EUS
examination as well as of ERCP cannulation and sphincterotomy on phantom models under
tutor supervision during sessions. There will be two EUS hands-on stations set up to learn
the technique of EUS-FNA (EUS-FNA phantom) and three ERCP hands-on stations allowing
to practice cannulation techniques, sphincterotomy, stent insertion and stone extraction.
Sessions are intended to be as interactive and practical as possible.

At the end of the course the participants are expected to understand:

• Main applications for EUS
• EUS anatomy and landmarks for orientation
• Principles for T-staging of GI tumors by EUS
• EUS-FNA technique with its indications and limitations
• EUS-guided therapy
• ERCP indications, contraindications, and complications
• ERCP cannulation techniques
• Biliary sphincterotomy, stent placement, stone extraction

Your faculty,
Livia Archibugi
Carola Fleischmann
Akin Inderson
Martin Kliment
Marianna Signoretti
Andrea Tenca

5
General abdominal ultrasound in gastroenterology

The aim of this session is an introduction to the ultrasound of the abdominal organs. In a
first theoretical part, the participants get to know the physical basics of ultrasound. Possible
indications, but also limitations of the examination technique are explained. Certain
conventions in the investigation technique, certain sound phenomena and artifacts are
explained. As a concrete example, the sonography of the hepatobiliary system is described
in more detail.

In a second practical part, the participants will have the opportunity to carry out ultrasound
examinations themselves: We will learn to systematically examine the liver, describe the
vascular architecture of the liver, correctly describe the parenchyma of the liver and
document possible focal lesions in their correct position. We will also study the gall bladder
and extra-/intrahepatic bile ducts. In the short time we try to perform an abdomen status with
examination of the liver, biliary tract, gallbladder, pancreas, spleen, kidneys, and urinary
tract. At the end of the lesson, participants should gain an impression of the power of
ultrasound in gastroenterological diagnostics.

Your faculty,
Giovanni Galati
Ivica Grgorevic
Christian Kielisch
Alina Popescu
Gabriela Suchankova

How to perform liver biopsy and elastography (hands-on)

Part 1 Interventional Hepatology: How to perform liver biopsy?

You work on the ward and there is this a yellow patient. Bile ducts are clear and there is an
indication of a liver biopsy but how to do it? Are there special precautions? This hands-on
teaching activity will update you on interventional hepatology.

• How to perform an ultrasound guided liver biopsy.

• How to perform an aspiration biopsy of the liver.

Ultrasound is a fine tool that can help you to perform interventional hepatology. We will
teach you how you can use ultrasound to perform a liver biopsy as a diagnostic tool. You will
be trained to perform a blind as well as ultrasound guided liver biopsy. We have an
ultrasound machine as well as phantoms available for hands-on training. You will receive
hands-on training on the technique of liver biopsy. You will receive valuable background
information on the indication and limitations of the procedures.

After the course the participant is aware of (educational goal):

• The use of ultrasound in interventional Hepatology
The indications for a liver biopsy
The various tools to perform a liver biopsy
The limitations of a liver biopsy

Teaching Tools:
• Lecture on liver biopsy as a diagnostic tool

6
Part 2 Elastography: How to do elastography?
You are at the outpatient clinic and see a patient with chronic hepatitis C. It is unclear how
long he has been infected and the patient knows how ‘bad’ his liver is affected. Clearly you
want to know if there is liver fibrosis and if so which grade. You have heard about fibroscan,
but are there alternatives? This hands-on teaching activity will update you on how to do
elastography using ultrasound.

• How to perform an ultrasound aided elastography?

Acoustic radiation force impulse (ARFI) technology has been gaining increasing relevance
at clinical routine during the last years. It allows us to quantify tissue elasticity in a defined
region of interest at B-mode ultrasound examination. As liver fibrosis makes the liver stiffer it
has for example been shown to be a useful tool to assess patients with liver disease. The
clinical use, technical aspects, standardized measuring, influencing factors and pitfalls will
be presented and trained during this practical skill session with the focus on liver disease.
Ultrasound is a fine tool that can help you to perform elastography.

We have an ultrasound machine as well as phantoms available for this hands-on training.
You will receive hands-on training on the technique of liver biopsy. You will receive valuable
background information on the indication and limitations of the procedures.

After the course the participant is aware of (educational goal):

• The use of ultrasound in interventional Hepatology
The indications for elastography
The various tools to perform elastography
• The limitations of elastography

Teaching Tools
• Lecture on non-invasive liver fibrosis assessment as a diagnostic tool

Your faculty,
Jeoffrey Schouten
Eric Tjwa

7
Indications for and hands-on training in percutaneous endoscopic
gastrostomy [PEG]

The PEG tube insertion is a major part of the daily activity in most endoscopic units.
However, some GI fellows are not being sufficiently exposed to training to develop
competence and confidence in this procedure with clinical experience alone. The aim of this
session is to improve participants’ procedural attitudes and confidence in PEG tube
placement. In the first theoretical part we will discuss all aspects of the PEG tube, including
indications and contraindications of PEG tube placement, along with potential complications
as well as their management and preventive measures. We will also provide necessary
information on pre- and aftercare including most important post-placement instructions for
carers.

In the second part the participants will be provided with hands-on experience in step-by-step
guidance on how to perform two most common techniques of PEG tube placement (“push”
and “pull”) using a low-fidelity PEG simulation model.

Your faculty,
Ivan Lerotic
Tajana Pavic
Valentina Ratkajec

New therapies in IBD: Practical approaches

The therapeutic armamentarium for IBD has increased in recent years. A better
understanding of the pathophysiology of the disease and the different inflammatory
pathways leading to chronic inflammations has paved the way for new therapeutic targets.
In this practical session, you will get an overview of the new approved drugs and those in an
advanced stage of development and their practical positioning in the current management of
ulcerative colitis and Crohn´s disease. Through practical clinical cases and group
discussion, we will review how to optimise the use of conventional drugs for IBD and how to
integrate the new biologics and small molecules in your clinical practice.

Learning objectives:
• Learn about the new biologics and small molecules for IBD.
• Understand the mechanism of action and practical application of new therapies in
clinical practice.
• Management of current drugs and learn how to optimise them in clinical practice.
• Exchange points of view and local experience in the implementation of new drugs
for IBD across Europe.
• Explore the role of new drugs in special situations in IBD.

Your faculty,
Imran Aslam
Ignacio Catalan-Serra
Daniela Pugliese
Iago Rodríguez-Lago
Paula Sousa

8
Reflux and motility studies: Practical approaches

Participants of the afternoon sessions on “pH metry and motility studies” will learn how
clinically useful it can be to investigate movements of fluids from the stomach to the
oesophagus (pH monitoring, pH+impedance monitoring) and how the oesophagus contracts
(oesophageal manometry). Sessions are intended to be as much interactive and practical as
possible. Participants will be exposed to clinical cases, manometric and pH monitoring
tracings, and will be able to propose and discuss management and diagnosis with the tutor.

Learning objectives:
• Understand principles and techniques of manometry, high resolution manometry,
pH monitoring, pH and impedance monitoring, wireless pH monitoring
• Indications and limitations
• Methods of analysis
• Review tracings of various dysmotilities and cases referred for pH/pH+impedance
monitoring

Your faculty,
Matteo Ghisa
Amir Mari