Educational objectives

1) Understand the management of rectovaginal fistulas in CD

to discuss the reasons for pouch dysfunction and failure
to explore the results of salvage surgery for the ileooanal pouch

Surgery is highly effective in treating Crohn’s disease, but is not curative, and up to half of the patients would suffer from surgical recurrence, and will require additional surgery. Redo surgery for Crohn’s is challenging, and may include cases who already had multiple surgeries, potentially with intraperitoneal mesh ventral hernia repairs, and imminent short bowel, and this is where sound surgical judgment, combined with superb technical skills are required.

Laparoscopy is a valid option for redo cases. However, even in experienced laparoscopic teams, approximately ¼ to 1/3 of the redo Crohn’s cases are being converted. Convertion should be pre-emptive, before complication occurs, instead of converting because an intraoperative complication has already been occurred.

In redo case, the length of the bowel becomes a prominent issue, and the surgeon should be as bowel preserving as possible on one hand, yet effective to induce remission on the other. Strictureplasty should be considered whenever possible.  Side-to-side isoperistaltic strictureplasty results in 37% surgical recurrence in a mean follow-up of 11 years, 1/3 of them were amenable for a second strictureplasty. In Strictureplasty over the ileocecal valve,  14% required additional surgery.

If strictureplasty is not feasible, and resection is mandatory, the common belief is that a large side-to-side anastomosis is associated with better long-term patency. However, The Kono-S anastomosis, preserving the mesentery, has been recently assessed in the SuPREMe-CD trial. At 18 months follow-up, endoscopic recurrence was found in only 25% of the Kono-S patients, compared to 67% in the conventional anastomosis group. This was translated to a significantly lower rate of surgical recurrence in 2 years. On the other hand, Coffey suggested that radical mesenteric resection was associated with significantly lower rate of surgical recurrence compared to historical control. Redo Crohn’s surgery requires experience and expertise, and should be done by dedicated and experienced IBD surgeons.

1. To understand the challenges of redo surgery for Crohn's disease 
2. To review the use of laparoscopy for redo surgery for Crohn's disease 
3. To discuss bowel length preserving techniques in surgery for Crohn's disease 
4. To discuss the long term results of different types of anastomosis for  surgery for Crohn's disease 

1. To describe the histopathology of ulcerative colitis and Crohn's disease
2. Histological activity in ulcerative colitis and Crohn's disease
3. To discuss the guidelines on sampling of biopsies in IBD

In this talk, we intend to compare the different existing histological scoring systems used in ulcerative colitis, as well as, the standards used for histological response and histological remission.

Educational objectives

1.What are the treatment goals in UC ?
2.Which clinical scores exist for UC ? Are they sufficient ?
3.Which endoscopic scores exist for UC ? Pros & cons ?
4.Which histologic scores exist for UC ? Pros & cons ?
5.When to take biopsies for FU of UC treatment ?
6.What are the treatment goals in CD ?
7.Are there clinical scores exist for CD ? Are they sufficient ?
8.Are there endoscopic scores for CD ? Pros & cons ?
9.How far are we with histologic scores for CD ?
10.Cautious recommendations for pathologists

In this slide seminar a complicated case of IBD in a pediatric patient will be discussed.
Educational objective:
- evaluation of a case in relation of clinical information
- to think on different diagnosis in IBD 

Objectives
1. The role of endoscopy in the surveillance of IBD-patients
2. The diagnosis of dysplasia and its subtypes on biopsies
3. The consequences for the treatment of the patient

Due to the continuous inflamed state of the mucosa, ulcerative colitis and Crohn’s disease patients are at risk of developing colorectal cancer at an earlier age and with a poorer prognosis. Hence continuous endoscopic surveillance with sampling of biopsies is necessary to detect the preneoplastic lesions in an early stage.  The SCENIC classification is a new endoscopic classification, which categorizes the lesions in to invisible and visible dysplasia.. Histologically these lesions consist of different subtypes, of which the adenomatous type is the most common. The presence of an inflamed mucosa complicates its diagnosis, resulting in a high interobserver variability in the categories indefinite for dysplasia and low grade dysplasia. Hence the ECCO-guidelines recommend to confirm the diagnosis of dysplasia by an expert pathologist in gastrointestinal pathology.

Eductional objective: To illustrate a rare mimicker of IBD pathology.

A middle-aged woman of Turkish origin complained of abdominal pain, watery diarrhea and vomiting since 3 weeks.
Lab tests were negative. Colonoscopy showed moderate to severe, patchy pancolitis.
Pathology was unclear.
She was treated with antibiotics and painkillers.
She went first into remission, and then did a relapse after one month.
At this time there was also arhtritis and oral as well as genital sores.
Colonoscopy showed patchy ulceration with dense perivascular inflammatory cell infiltrates, but without granulomas.

Your diagnosis?

Ulcerative Colitis and Crohn's disease have different macroscopic appearances.
Both diseases show unique and peculiar macroscopic features and it is important to recognise them in order to sample IBD specimens correctly.
The macroscopic examination is the first step for a correct pathological analysis and it is essential for the histological examination.
Educational objectives:
-To identify basic macroscopic features of UC and CD.
-To sample the specimens correctly.
-To recognise elementary lesions.
-To do not underestimate IBD samples.

Educational objectives:
•Synthesis and structure
•Mechanism of action
•Effects on inflammatory and immune processes
•Pharmacology  and formulations
•Efficacy of steroids as anti-inflammatory agents in inflammatory bowel diseases (IBD)
•Safety and complications

To understand the value of pathology in reporting/documentation of the course of IBD diseases
To understand the value of pathology in guiding surgical treatment of Crohn and ulcerative colitis

1. To understand the surgical strategies and surgical implications of surgery in IBD
2. To review surgical techniques and decision making in surgery for IBD
3. To emphasise multidisciplinary team working and patient involvement in decision making
4. To promote the role of the specialist IBD nurse in providing care, education, and counselling to Crohn and colitis ulcerosa patients

To understand the differential role of MRE and intestinal ultrasound (IUS) in the diagnostic work up of IBD

Educational objectives:

1. What is the role of appendectomy in the clinical course of UC?

2. Can appendectomy prevent colectomy for UC?

3. Who will respond to appendectomy?

4. Patients with ulcerative appendicitis are more likely to respond to appendectomy

5. The presence of PARP is predictive of ulcerative appendicitis