THANK YOU TO EVERYONE WHO MADE THE 2022 COURSE A SUCCESS!

This is the 37th year of the course, “Medical and Surgical Aspects of Esophageal and Foregut Disorders: Pathophysiology and Treatment”. We are pleased to announce that the venue for the 2022 course will be the Fairmont Orchid on the Big Island of Hawaii. 

COURSE Overview

For those that have not attended previously, the course is specifically designed to have the feel and interaction of a small-group classroom environment where questions, comments and discussion are encouraged. The course is open to all physicians and allied health personnel with an interest in esophageal and foregut disorders.  It is particularly appreciated by gastroenterologists and gastrointestinal surgeons who focus on the diagnosis and treatment of patients with esophageal disorders, and for those who have or an interest in developing a swallowing center and who function as a team to collaboratively approach esophageal problems. The lectures are detailed and supported by existing literature and on-going research to provide cutting-edge information that can be immediately applied to patient care. Each lecture is followed by ample time for often vigorous discussion and interaction between the faculty and attendees as areas of controversy are further explored and debated.

In addition, there are lunch and learn sessions that provide even deeper dives into relevant and often controversial subjects, an “Interactive New Technology” break-out session to provide participants with the opportunity to gain insight into new and evolving technologies that impact esophageal diagnostics and therapy, and optional Hands-on Certificate Sessions.  In these sessions, participants have close interaction with faculty and vendors on new technology and procedures to enable the participant to leave with a new level of confidence and experience along with a certificate of completion at the end of the advanced session. These sessions typically include high-resolution motility, advanced endoscopic procedures and novel diagnostic or therapeutic devices.

The course is intense, but we also encourage socialization among the participants and faculty. This is aided by a course reception Thursday night and a wonderful evening social event on Monday night. This year we are adding a poolside cocktail event for participants to interact with the faculty in a relaxed environment and hear stories from their careers, discuss cases, share thoughts on the future of foregut and enjoy the beauty of Hawaii together poolside. The course starts Thursday and ends Tuesday, with Sunday a free day for everyone to unwind and recharge.

Agenda

THURSDAY, FEBRUARY 10

  • 6:00 AM  Continental breakfast/Introductions and welcome (S. DeMeester & P. Katz)

SESSION 1: Esophageal diagnostics and GERD (Moderator: Steve DeMeester)

  • 6:30 AM Defining GERD: Time to move beyond Montreal? (S. DeMeester)

  • 7:30 AM  HRM in a GERD evaluation (P. Katz)

  • 8:15 AM  Bravo pH and MII-pH, when and how to use (S. Spechler)

  • 9:15 AM  Mucosal impedance: A must-have for 2022? (M. Vaezi)

  • 10:00 AM  Coffee break/Case presentations

  • 10:30 AM Potassium Channel Acid Blockers (PCABs): New Option for Severe GERD (P. Katz)

  • 11:15 AM  Upper endoscopy in GERD: don’t miss the disease! (F. Schnoll-Sussman)

  • 12:00 PM  Surgery for benign esophageal disease in the complex patient (D. Molena)

  • 12:45 PM  Lunch and learn debate: Extra-esophageal and LPR symptoms

    • Medical perspective (M. Vaezi)

    • Surgical perspective (S. DeMeester)

  • 1:45 PM break

  • 2:30 PM  Hands-on session:

    • Motility

  • 4:00 PM  Adjourn

  • 5:30 PM  Welcome reception at the Croquet Lawn – All participants 

FRIDAY, FEBRUARY 11

  • 6:00 AM Industry Break the Fast with Science vendor-sponsored.

    Speaker: Tanuja Damani, MD Associate Professor, Surgery NYU Grossman School of Medicine Controversies in Paraesophageal Hernia Repair: Short esophagus, Mesh, Wraps and Now Robotics?

SESSION 2:  GERD I (Moderator: Phil Katz)

  • 7:00 AM  What is cardiac mucosa and why should I care? (P. Chandrasoma)

  • 8:00 AM  The evolution and current status of fundoplication for GERD (J. Hunter)

  • 9:00 AM Nissen vs Toupet and what about Watson, Hill and LINX? (L. Swanstrom)

  • 10:00 AM  Extended coffee break/Case presentations

  • 10:45 AM Where does Stretta, TIF and c-TIF fit in? (K. Chang)

  • 11:30 AM c-TIF counterpoint and things to ponder (S. DeMeester)

  • 12:30 PM Indications, outcomes and tips for redo antireflux surgery (N. Soper)

  • 1:15 PM Lunch and learn, vendor-sponsord

    • Deep dive into LES (T. DeMeester)

    • Reflections on RFA for Barretts’s (S. DeMeester)

  • 2:30 PM Hands-On Sessions:

    • Flip/Barrx

    • Clips/Stents

  • 4:30 PM  Adjourn

SATURDAY, FEBRUARY 12

  • 6:00 AM Reflections on the history and future of foregut as a speciality and thoughts about what the future foregut physician looks like (Panel: S. Spechler, L. Swanstrom, N. Soper, J. Hunter, J. Peters, T. DeMeester)                                

SESSION 3: GERD II  (Moderator: Stu Spechler)

  • 7:00 AM  Debate: Who should have antireflux surgery?

    • Surgical perspective: (L. Swanstrom)

    • GI perspective: (S. Spechler)                               

  • 8:15 AM  Break Out Rooms with Industry

    •  6 vendors, 15-20 min each room

  • 10:15 AM  Coffee break/Case presentations

SESSION 4:  PEH (Moderator: Steve DeMeester)

  • 10:45 AM  Indications for PEH repair in 2022: is a change afoot? (S. DeMeester)

  • 11:30 AM  Takeaways from the PEH trials: what to do now? (N. Soper)

  • 12:30 PM  The rise, fall and rise again of the Collis gastroplasty: here to stay? (J. Hunter)

  • 1:15 PM Adjourn

  • 4:30 PM  Poolside cocktails, cases, stories, and strategies to manage the unhappy patient and advice to fellows and young physicians starting their foregut careers (Kahakai Bar)

SUNDAY, FEBRUARY 13 – FREE DAY

MONDAY, FEBRUARY 14

  • 6:00 AM   Early risers video session                                                                                                

  • 6:30 AM   Continental breakfast/Case presentations

SESSION 5: Achalasia symposium (Moderator: Felice Schnoll-Sussman)

  • 7:00 AM Overview of etiology and pathogenesis (S. Spechler)

  • 7:45 AM Achalasia subtypes: Implications for treatment and outcome? (M. Vaezi)

  • Rapid-fire overview of therapies and issues with achalasia treatment

    • 8:30 AM Botox and PD: Who and how? (P. Katz)

    • 8:45 AM  POEM (L. Swanstrom)

    • 9:00 AM   Management of PD and POEM complications (K. Chang)

    • 9:15 AM Lap Heller and fundoplication (J. Hunter)

    • 9:30 AM Robotic heller (S. DeMeester)

    • 9:45 AM  How to define success and failure (P. Katz)

    • 10:00 AM  Management of treatment failure (N. Soper)

    • 10:15 AM  The issue of GERD after achalasia therapy (F. Schnoll-Sussman)                                               

    • 10:30 AM  Roundtable discussion

  • 10:45 AM  Coffee break/Case presentations

SESSION 6: Motility disorders, diverticula, and intramural lesions I (Moderator: Steve DeMeester)

  • 11:15 AM  Zenker’s (L. Swanstrom)

  • 12:00 PM  Management of the epiphrenic diverticulum (N. Soper)

  • 12:45 PM  Adjourn

  • 6:30 PM  Course reception at the Croquet Lawn - All participants

TUESDAY, FEBRUARY 15

  • 6:00 AM Scary short case report                                                                                              

  • 6:30 AM  Continental breakfast/Case presentations                                                                   

SESSION 7: Motility disorders, diverticula and intramural lesions II (Moderator: Phil Katz)

  • 7:00 AM  Challenges and frontiers for endoscopic foregut procedures (L. Swanstrom)

  • 8:00 AM   Endoscopic Interventions: Strictures, Diverticula, SMT's (K. Chang)

SESSION 8: Barrett’s esophagus and adenocarcinoma (Moderator: Steve DeMeester)

  • 8:45 AM  Insights into the GEJ and foregut IM (C. Marginean)

  • 9:45 AM  Are we doing enough for our patients with Barrett’s? (D. Molena)

  • 10:30 AM  Coffee break/Case presentations   

  • 11:00 AM  EMR and ESD in the esophagus and stomach (K. Chang)

  • 11:45 AM Failure of endotherapy: the dirty and not so little secret (D. Molena)

  • 12:30 PM  Adjourn

ACCREDITATION

Accreditation: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of HCA Healthcare Continental Division and Foregut Foundation. The HCA Healthcare Continental is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation: The HCA Healthcare Continental Division designates this live activity for a maximum of 28.75 AMA PRA Category 1 CreditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

 Commercial Support: This Activity was developed without support from any ineligible company.* The ACCME defines ineligible companies as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. Note: The ACCME does not consider providers of clinical service directly to patients to be commercial interests – unless the provider of clinical services is owned, or controlled by, and ACCME defined ineligible company.

 ABIM MOC: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 28.75 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

 Disclosures:

The HCA Healthcare Continental Division Office of CME (OCME) and its affiliates are committed to providing educational activities that are objective, balanced and as free of bias as possible. The OCME has established policies that disclose to the audience, verbally or in writing, any commercial relationships that might be perceived as a real or apparent conflict of interest related to the content of their presentations, and unlabeled/unapproved uses of drugs and devices. Detailed disclosures are made verbally and/or in writing during the program. The HCA Healthcare Continental Division is accredited by the Accreditation Council for Continuing Medical Education (ACCME). In order to participate as a person who will be able to control the educational content of accredited CME activities, we ask that individuals disclose all financial relationships with any ineligible companies over the past 24 months. The ACCME defines ineligible companies as those whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients. There is no minimum financial threshold; we ask individuals to disclose all financial relationships, regardless of the amount, with ineligible companies. For more information on the Standards for Integrity and Independence in Accredited Continuing Education, please visit accme.org/standards.

 The ACCME considers financial relationships to create conflicts of interest in CME when individuals have both a financial relationship with ineligible companies and the opportunity to affect and influence the content of CME about the products or services of that ineligible company. The potential for maintaining or increasing the value of the financial relationship with the ineligible company creates an incentive to influence the content of the CME—an incentive to insert commercial bias. The ACCME has not set a minimum dollar amount for relationships to be considered relevant and does not use the term significant to describe financial relationships. Inherent in any amount is the incentive to maintain or increase the value of the relationship.

 Why do we collect this information?

Since healthcare professionals serve as the trusted authorities when advising patients, they must protect their learning environment from industry influence to ensure they remain true to their ethical commitments. Many healthcare professionals have financial relationships with ineligible companies. By identifying and mitigating financial relationships, we work together to create a protected space to learn, teach, and engage in scientific discourse free from influence from organizations that may have an incentive to insert commercial bias into education.

The HCA Healthcare Continental Division is committed to providing CME that is balanced, objective, and evidenced-based. In accordance with the Accreditation Council for Continuing Medical Education Standards for Integrity and Independence all parties involved in content development are required to disclose all conflicts of interest with ACCME defined ineligible companies. The HCA Healthcare Continental Division has identified, reviewed, and mitigated all conflicts of interest that speakers, authors, course directors, planners, peer reviewers, or relevant staff disclose prior to the delivery of any educational activity. The CME planning committee who are in a position to control the content of this CME Activity, have no relevant financial relationships with ineligible companies to disclose.

Core Competencies: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The HealthONE Health System and Foregut Disease Foundation. The HealthONE Health System is accredited by the ACCME to provide continuing medical education for physicians. 

 
 
 

Faculty Information

This year we are pleased to again bring together outstanding leaders in the field of Esophageal Disease as faculty. The faculty brings broad experience in benign and malignant esophageal disease and includes a mixture of gastroenterologists and surgeons from diverse locations to ensure a comprehensive, state-of-the-art, yet balanced approach to the diagnosis and management of patients with esophageal and foregut disorders.

The course was started by Drs Tom DeMeester and Don Castell.  Tom DeMeester was Professor of Surgery and Chairman of the Department of Surgery at the University of Southern California. He is world-renown for his numerous contributions in the field of esophageal disease, including the development of the DeMeester score to assess esophageal acid exposure during pH testing. He remains a dynamic part of this annual course. Don Castell was Professor of Medicine and Director of Esophageal Function Laboratory at the Medical University of South Carolina, Charleston SC. He was internationally renowned for his contributions to esophageal function testing as well as diagnosis and therapy for gastroesophageal reflux disease. Sadly, Don passed away in 2021 but he will be long remembered for his detailed lectures on esophageal physiology, quick mind and gregarious spirit while debating Tom and the other surgeons at the annual course.  His legacy lives on with the spirited discussions that are a tradition at this course.

Currently, the course is co-directed by Steve DeMeester, MD and Philip Katz, MD. Steve DeMeester is Director of esophageal surgery within the division of thoracic surgery specializing in foregut disease and is currently at The Oregon Clinic in Portland, OR. Prior to moving to Portland, he was Professor of Surgery and Clinical Scholar at the University of Southern California. Philip Katz is a Gastroenterologist specializing in esophageal diagnostics and therapy and is a Professor of Medicine at Weill Cornell Medicine, NYC. Prior to moving to Cornell, Phil was Chief of Gastroenterogy and Nutrition at the Albert Einstein Medical Center, Jefferson Medical College in Philadelphia, PA. He is a past president of the American College of Gastroenterology.

Emeritus director Jeff Peters MD, and core faculty Stu Spechler MD, Felice Schnoll-Sussman MD, Para Chandrasoma MD, Celia Marginean MD and Daniela Molena MD remain integral to the outstanding content and discussions each year at the course. Jeff Peters was Professor of Surgery and Chairman of the Department of Surgery at The University of Rochester, and then his most recent position was Chief Operating Officer for University Hospitals Healthcare System in Cleveland, OH. Stu Spechler is Chief, Division of Gastroenterology and Co-Director, Center for Esophageal Diseases at Baylor University Medical Center at Dallas and Co-Director, Center for Esophageal Research at Baylor Scott & White Research Institute. Felice Schnoll-Sussman is Professor of Clinical Medicine and Director of the Jay Monahan Center for Gastrointestinal Health and Director of Endoscopy, Division of Gastroenterology and Hepatology, Weill Cornell Medicine. Para Chandrasoma, Professor of Pathology at USC-LAC, is one of the world’s leading experts in esophageal pathology. Celia Marginean is Professor of Pathology at Baylor College of Medicine. Daniela Molena is Associate Professor of Surgery at Memorial Sloan Kettering. Each faculty brings expertise and broad clinical experience on esophageal disorders.

In addition to the core faculty each year there are special surgical and medical guests, from national or international locations, to highlight the specific topics that are focused on at each year’s meeting. These topics include esophageal diagnostics, endoscopic imaging and interventions, the pathology of GERD and Barrett’s esophagus, esophageal motility abnormalities and diverticula, hiatal hernia, laryngopharyngeal reflux, medical, surgical, and endoscopic therapies for GERD and motility disorders, esophageal perforation and caustic injury, eosinophilic esophagitis, benign tumors of the esophagus and stomach, and the diagnosis, staging, and therapy for esophageal and gastric cancer.

FEATURED ON THE MEDICINE SIDE for 2022

Kenneth J. Chang, MD, FACG, AGAF, FASGE, FJGES

Executive Director, Digestive Health Institute Medical Director, Chao Family Comprehensive Digestive Disease Center Division Chief, Gastroenterology and Hepatology, Department of Medicine Professor of Clinical Medicine, University of California, Irvine

Dr. Chang is the founding Executive Director of the Chao Family Comprehensive Digestive Disease Center (CDDC) as well as the newly established UCI Health Digestive Health Institute (DHI). He is also Professor and Chief of the Division of Gastroenterology and Hepatology. Dr. Chang’s clinical research for over three decades has focused on developing and expanding the field of interventional gastrointestinal endoscopy with a specific focus on digestive malignancies and precancerous lesions. Dr. Chang has focused on precancerous conditions of the Digestive System with the goal to improve detection, risk stratification, and clinical strategies that culminate in a personalized approach toward treatment and cure. In addition to his expertise in GI malignancies and Barrett’s, he is also an expert in Per-oral endoscopic myotomy (POEM) in the treatment of Achalasia, endoscopic submucosal resection (ESD) of early cancers and Endoscopic sleeve gastroplasty (ESG) for obesity. He is also an authority on Trans-oral Incisionless Fundoplication (TIF) in the treatment of GERD.

Dr. Chang holds the Vincent and Ana Kong Chair in Gastrointestinal Endoscopic Oncology and has published over 470 peer-review articles, review papers, book chapters and abstracts, as well as Editor of 4 textbooks. These scientific publications include 5 major topics: EUS-guided tissue acquisition, new diagnostic approaches to Pancreatic Cystic Neoplasia, Endo-Hepatology, GERD/Barrett’s Esophagus, and 3rd-space endoscopy (myotomy and cancer resection).

Michael Fredrick Vaezi, M.D., Ph.D.

Professor of Medicine and Otolaryngology / Director of the Center for Swallowing and Esophageal Disorders / Vanderbilt University Medical Center, Nashville, TN

Dr. Vaezi is currently a Professor of Medicine and Otolaryngology at the Vanderbilt University Medical Center in the Division of Gastroenterology, Hepatology and Nutrition.  He is the Associate Chief and Clinical Director of the Division and Director of Center for Swallowing and Esophageal Disorders and Director of Clinical Research. He is immediate past Chair of the EGD Section of the AGA and is currently Associate Editor for Gastroenterology and member of the AGA research Council. 

Dr. Vaezi received a B.S. degree in Chemistry at Birmingham-Southern College in Birmingham, Alabama.  He then went to the University of Alabama at Birmingham and received his Ph.D. in Bio-Organic Chemistry.  From there, Dr. Vaezi went to the University of Alabama School of Medicine where he received his MD degree in 1992. He completed a four-year academic residency in internal medicine in a program focused on clinical research at the University of Alabama Hospitals in Birmingham Alabama.  Subsequently, he completed his fellowship in Gastroenterology at the Cleveland Clinic Foundation where he was elected as the Chief Fellow.   He also received a Master’s in Epidemiology and Clinical Research from Case Western Reserve University. Dr. Vaezi is an associate member of the American Gastroenterological Association and a Fellow member of the American College of Gastroenterology

FEATURED ON THE SURGICAL SIDE for 2022

John Hunter, MD

Executive Vice President and Chief Executive Officer / The Oregon Health Science University / Portland, Oregon

Dr. John Hunter was born in Hanover, New Hampshire in 1955. He attended Harvard College, where he graduated with a degree in English Literature, and then attended medical school at the University of Pennsylvania. He did his surgical residency at the University of Utah, with fellowships in surgical endoscopy at the Massachusetts General Hospital and the University of Western Ontario. In 1988 he returned to Utah to start the minimally invasive surgery program. In 1992, he relocated to Emory University in Atlanta, where he served as Chief of GI surgery and Vice-Chair of Surgery (clinical). Dr. Hunter next went to Oregon Health & Science University to become the Mackenzie Chair of Surgery and Surgeon in Chief of the OHSU health system in 2001. He was the Interim Dean of the OHSU School of Medicine in 2016-17, then became the Chief Clinical Officer and Chair of the OHSU Practice Plan. Since late 2017, Dr. Hunter has served as an Executive Vice President of OHSU and the Chief Executive Officer of OHSU Health, a four-hospital University-based system health system in Portland, Oregon.

Dr. Hunter served the American Board of Surgery (ABS) for 13 years, chairing the ABS in 2016-17. He has been President of several international surgical societies including the SSAT and SAGES. Dr. Hunter is currently the President of the International Society of Surgery (ISS-SIC). He has received several honorary fellowships, including the European Association of Endoscopic Surgeons, the European Surgical Association, the Royal College of Surgeons of Edinburgh and the Spanish Society of Surgeons. He was the Editor in Chief of the World Journal of Surgery from 2005 until the end of 2017.

Nat Soper, MD

Chairman, Department of Surgery / University of Arizona College of Medicine and Banner University Medical Center / Phoenix, Arizona

Nathaniel J. Soper was raised in Iowa City, Iowa, as the son of a pediatric surgeon. He got his medical degree from the University of Iowa , then did a residency in General Surgery, including a year of laboratory investigation under the mentorship of Layton F. Rikkers, at the University of Utah Hospitals in Salt Lake City, Utah. Dr. Soper then spent two years as an NIH-funded fellow at the Digestive Disease Center at the Mayo Clinic in Rochester, Minnesota, mentored by Keith Kelly and Michael Sarr. He joined the faculty of the Department of Surgery at Washington University School of Medicine in 1988, and rose to the rank of Professor of Surgery. He was one of the first academic surgeons performing laparoscopic surgery, which has defined his subsequent career. 

In December, 2003, Dr. Soper was appointed Professor of Surgery, Vice-Chair for Clinical Affairs and Director of MIS at Northwestern University Feinberg School of Medicine. He was named Residency Program Director for General Surgery in 2006 and on July 1, 2007 he was appointed the Loyal and Edith Davis Professor and Chairman of the Department of Surgery at Northwestern University and Surgeon-in-Chief at Northwestern Memorial Hospital. He resigned as Chair in March 2019, and was subsequently appointed as Chairman of the Department of Surgery at the University of Arizona College of Medicine-Phoenix and Chief of Surgery at Banner University Medical Center-Phoenix in September, 2020.

Dr. Soper's research interests have revolved around the applications of MIS for gastrointestinal disease, gallstones and benign esophageal disorders. He has published more than 200 manuscripts, edited 17 textbooks and authored more than 100 book chapters. Dr. Soper has been named in "The Best Doctors in America" from 1991 through the present and has lectured extensively throughout the world. Dr. Soper is Past-President of the Society for Surgery of the Alimentary Tract, the Society of American Gastrointestinal and Endoscopic Surgeons, the International Society of Digestive Surgery, the Central Surgical Association and the St. Louis Surgical Society.  Dr. Soper was elected as a Founding Member of the American College of Surgeons Academy of Master Surgeon Educators in 2018.

Lee Swanstrom, MD

Scientific Director and Chief Innovations Officer / Institutes des Hopitaux Universitaires / University of Strasbourg, France

Dr. Swanstrom is Professor of Surgery at The Oregon Health and Science University, current Director of the American Board of Surgery, past President of the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) and is a founder and Board Member of the American Foregut Society. Dr. Swanstrom received his MD degree from Creighton University following undergraduate work at the University of Paris (Sorbonne) and University of Colorado. He completed an internship and residency in general surgery in Portland and a fellowship in surgical endoscopy and GI surgery at the University of Western Ontario. Dr. Swanstrom's clinical focus is on minimally invasive treatments of a variety of esophageal and gastrointestinal disorders, particularly utilizing laparoscopy and interventional flexible endoscopy. He is a well-known educator and researcher with over 350 scientific papers, 75 book chapters and is the editor of 3 major surgical textbooks and the journal Surgical Innovation. His research focus is on foregut physiology, human factors and technology assessment and new procedure development. This has resulted in 23 patents and several medical device startup companies. He serves as a consultant to a large number of past and current medical device companies, but his greatest pride has been the large numbers of fellows and residents who have been inspired to push the envelope in the field of GI surgery.