Special Session 3 - The Shifting Paradigm of Gastrointestinal Disease Management

Endoscopy has evolved as a diagnostic and therapeutic tool for gastrointestinal diseases. With the advanced development in imaging, there is significant improvement in detection of early gastrointestinal neoplasia. Recently, screening program has been implemented around the world on colorectal cancer and detection of early colorectal neoplasia had increased. Nowadays, detection and characterization of early gastrointestinal neoplasia is greatly improved with use of image enhanced endoscopy with magnification. However, the interpretation of the features to characterize early GI neoplasia required significant knowledge and focus of the endoscopist. 
The recent development in Artificial Intelligence (AI) through deep learning allowed interpretation of image data in a short period of time, making immediate detection and characterization of early GI neoplasia possible during endoscopy. AI will enhance the workflow of diagnostic and therapeutic endoscopy in terms of quality, safety and efficiency. In collaboration with a local HK startup, we developed an AI driven system for quality control of diagnostic Esophago-gastro-duodenoscopy (EGD). In a prospective clinical trial, the completeness of diagnostic EGD was significantly higher with the use of Cerebro (AI system) among endoscopists trainee compared to those without using AI. 
AI has also extended to application in improving detection of colorectal polyps and neoplasia. In a large prospective randomized trial conducted at endoscopy center of Prince of Wales Hospital, we confirmed that use of EndoAID could increase the overall adenoma detection rate among junior endoscopists in  training especially for small-to-medium size and non-pedunculated adenomas, in different locations of colon and different levels of experience.
Our team is now developing an AI system in assisting the performance of gastric endoscopic submucosal dissection (ESD) for treatment of early gastric cancer. The initial experiment demonstrated a high efficiency in predicting trajectory during ESD. In future, this system will be able to provide real-time guidance towards the safest plane for submucosal dissection during ESD.

Colorectal cancer (CRC) has emerged as the second most common cancer and the second leading cause of cancer death in Hong Kong. Surgery still remains the mainstay of curative treatment for CRC. However, about 50% of patients are diagnosed at more advanced stages and require further multimodal treatment. Management of advanced rectal cancer is even more complicated, and judicious use of preoperative chemoradiation is often needed to increase resectability rate and avoid the need for a permanent stoma. In the New Territories East Cluster (NTEC), we have established a Lower Gastrointestinal Cancer (LGIC) Multidisciplinary Team (MDT) consisting of different healthcare professionals and academics to deliver a highly efficient, evidence-based, personalised, and patient-centred care to our CRC patients. Through pioneering advances in minimally invasive surgery, cancer diagnostics, oncological service, and cancer-related research, the NTEC LGIC MDT is committed to provide the best care possible to our CRC patients with passion and professionalism. In this lecture, I will share with the audience our multidisciplinary approach for CRC in NTEC.

People are not just people. They are an awful lot of microbes- trillions of them which reside in the human gut (bacteria, virus, fungi). Today, the microbiome is the buzzword in everyone’s tip of mouth, literally. Many if not most diseases can be traced back to disruption of the microbiome. While we have limited control over which of our genes are regulated, and how genes are expressed, our microbiome can be manipulated with direct medical intervention. “We call the gut the second brain”. Colon cancer, COVID-19, obesity, even autism and depression are being shown to be due to changes in the microbiome. We found that bacteria DNA from the human gut can be used as accurate diagnostics allowing disease screening, detection and prediction to be done with one stool test rather than a more invasive procedure. We can make “magic” of faeces. Fecal transplant has revolutionized management of recurrent clostridioles difficile infections. I would ask the question, people bank blood, why not feces? We advocate the establishment of a modern version of ‘Noah’s Ark’ to process and store gut microbiome biosamples in the Loop Area. Storing your stool when you were young may save you later in life. In this lecture, I will discuss the potential utility of our microbiome for the better health of our next generation.