Day 2 :
Keynote Forum
Sambhaji Govind Chintale
Muhs Nashik University, India
Keynote: Correlation of HRCT mastoid with clinical presentation and operative findings in ear diseases
Time : 09:00-09:45
Biography:
Sambhaji Govind Chintale is currently working as Associate Professor in ENT department at JIIUs Indian Institute of Medical Science & Research. He is a Senior Resident at Kem Hospital, Mumbai from 1st Feb to 31st Jul 2012 and Senior Resident at DR. R N Cooper Hospital, Mumbai from 15th Sep to 15th Jan 2013. He has published many papers in reputed journlas like Indian Journal of Basic and Applide Medical Research, Otolaryngology Online journal, and International Journal of Recent Trend in Science and Technology.
Abstract:
Background: HRCT is found to be extremely useful for evaluating the ear diseases involving the external auditory canal, middle ear cavity, vertical segment of facial nerve canal, vestibular aqueduct, tegmen tympani, sigmoid sinus plate, sinodural angle, carotid canal, jugular fossa, infra and supralabrynthine air cells and temporomandibular joint. Our main objective was to correlate the clinical presentation and operative findings of ear diseases with HRCT mastoid.
Methods: This study is done in our institute’s Otorhinolaryngology dept. from April 2014 to April 2016. This is a prospective study which involves 36 patients belonging to different ages and sex groups with high suspicious of ear diseases. We have taken detailed history of each patient with complete ear nose throat examination, and after that all patients were investigated with routine blood investigation, X-ray and HRCT mastoid to correlate clinical finding and subjected for operation to compare operative findings with HRCT finding.
Results: Pearson Chi Square test indicated a statistically significant correlation between HRCT temporal bone with clinical presentation and operative findings of ear diseases [P<0.05].
Conclusion: With the advent of modern high-resolution CT scanners, detailed demonstration of temporal bone anatomy is practically possible now. We have been able to identify many significant structures not demonstrated by any of the known imaging modalities. The improved contrast and soft tissue, a definition possible with HRCT has resulted in production of excellent images of soft tissue lesions in air spaces. Hence HRCT appears to be the diagnostic modality of choice for cholesteatomas and other soft tissue lesions in middle ear
Keynote Forum
MMT Vasan
Apollo Cosmetic Surgical centre & V-Graft Hair Transplant centre, India
Keynote: Graft survival in hair restoration surgery
Biography:
Dr. M M T Vasan practices at Apollo Spectra Hospitals. Professional qualification of the Doctor is MBBS, MS, Fellowship in Plastic & Cosmetic Surgery and specializes in Plastic and Cosmetic Surgery. Dr. M M T Vasan has expertise in Cosmetic Surgery with an experience of 7 Years.
Abstract:
Introduction: Hair transplant is a common cosmetic surgery. Finer & newer techniques are coming up very often. Identifying and modifying the factors that affect graft survival have received a great deal of attention.
Materials & Methods: Harvesting done by Follicular Unit Transplant (FUT) and Follicular Unit Extraction (FUE). By adding good buffering solution for the graft storage and PRP application during the hair transplantation increases the graft survival. The factors affecting graft survival are discussed under the following headings: A. Follicular trauma – Mainly occurs by transection, dehydration and crushing of the grafts; B. Bio chemical factors – Lack of O2, blood, nutrients and pH shift; C. Vascular factors – Refers to immediate post-operative oxygen supply and revascularization.
Results & Analysis: Suction assisted hair transplant with good buffering storage for the graft survival and PRP application during hair transplant has be done around 350+ cases in past 5 years.
Conclusion: Graft survival can be increased to greater extend by reducing the follicular trauma, storing the grafts in good buffering solution and by PRP application
Keynote Forum
Padma Shri Dr. Jitender Mohan Hans
Dr. Hans Centre for ENT, Hearing Care & Vertigo, India
Keynote: Understanding temporal bone aqueducts in cochlear implant surgery
Biography:
Padmashree awardee Prof. (Dr) J. M. Hans, is a topper and medalist from PGI Chandigarh. Dr. Hans has done pioneering work in the field of cochlear implant surgery and has done more than 1500 cochlear implants in his center, centers around the country and also in SAARC countries. He is the Founder Member of the Cochlear Implant Group of India. He is currently Chairman& Director of Dr. Hans Centre for ENT & Cochlear Implant and Chairman of Dept of ENT & Cochlear Implant, Venkateshwar Hospital, Dwarka, New Delhi. He is Honorary Consultant to Ex-Prime Minister of India. Dr. Hans is Government Member to the Ali Yajur Jung National Institute for Deafness, Mumbai. The Government appointed him as Executive Member of the All India Institute of Speech and Hearing, Mysore. He is appointed Member to the National Program on Prevention and Control on Deafness (NPPCD) and Advisor to UPSC and WHO. He pioneered the minimally invasive technique for Cochlear Implantation in India. He is also advisor Cochlear Implant Surgeon to Pingalwara Trust in Amritsar. He is visiting cochlear implant surgeon to the Medical Colleges of Chattisgarh, Andhra Pradesh and Madhya Pradesh, PGI Chandigarh etc., to perform CI surgery on deaf and dumb children.
Member of ADIP, Committee of Cochlear Implant, Govt. of India and Executive Council AIISH Mysore.
Abstract:
Aim: To understand and assess the presence of abnormal cochlear aqueduct and vestibular aqueduct and their presentation during cochlear implant surgery
Methods: The study involved 100 cases of a large cochlear aqueduct and 50 cases of large vestibular aqueduct which were identified on radiological assessment prior to surgery. The cases were operated by the same surgeon and by VERIA technique. The large cochlear aqueducts presented with CSF gushers after cochleostomy and the large vestibular aqueducts presented as pulsatile leak of perilymph. The cochleostomy in large cochlear aqueducts and the large vestibular aqueducts cases were sealed at the time of the CSF leak by the three handed technique in VERIA technique with a dumbbell shaped tissue seal or by using the specially designed electrode array.
Results: Large cochlear aqueducts presented with CSF gushers on cochleostomy which required a better preparedness during surgery to seal the cochleostomy at the time of the gusher to obtain a complete seal and the large vestibular aqueducts presented as a mild pulsatile leak of perilymph which was self-limiting and was easily sealed using tissue. All cases were sealed well at the cochleostomy and did not require any lumbar drain.
Conclusion: Better access provided by VERIA technique provides the surgeon a complete access to the cochlea which enables a three handed control of the gushers for better sealing of cochleostomy. Knowing the aqueducts radiologically prior to surgery is a must for every cochlear implant surgeon.
Keynote Forum
Alessandro Bucci
ASUR Marche, Italy
Keynote: The use of oral probiotics in the prevention of upper respiratory tract infections
Biography:
Alessandro Bucci is the Head of Sleep Apnea Center and Rhinology/Rhino-Allergology Center - Otolaryngology department, ASUR Marche, AV2 – Senigallia, Italy. He is an International Faculty Member of the XXXV Pan-American Congress of Otorhinolaryngology 2016, Cuba, Past Director of the 1st International Conference on Rhinology and Rhino-Allergology/5th Bulgarian Italian Rhinology Meeting, 2016 Senigallia (Italy), Committee Member and Chairman of the International Specialists Conference on Ear, Nose and Throat Disorders, November 2016 Alicante (Spain). In the past, he was a University Professor at the UNIVPM, Ancona, Italy. He attended Medical school at Catholic University (UCSC) in Rome, and completed his Residency in Otolaryngology-Head and Neck Surgery at UCSC - Gemelli Hospital in Rome. He is a Reserve Medical Officer of the Italian Navy and Consultant in Otolaryngology from 2002. He obtained PhD (in Rhinology and Rhino-Allergology) in 2006 at UCSC, Rome and a Fellowship in Otolaryngology in Spain (University Hospital, Cadiz). He held Fellowships in Facial Plastic Surgery (AMC) and OSAS (Sint Lucas Andreas Hospital) in Amsterdam, The Netherlands, and in Facial Plastic Surgery in Calixto Garcia University Hospital, La Habana, Cuba. He is Vice-president of the ONLUS association: “ANATRA.it” (National Association of Tracheotomised Patients) and is a Member of the ERS (European Rhinologic Society).
Abstract:
At the start of the 20th century (in 1908), Russian Noble Prize winner and Father of Modern Immunology, E. Metchnikoff, a scientist at the Pasteur Institute, observed that a surprising number of people in Bulgaria lived more than 100 years. Metchnikoff observed that Bulgarian peasants consumed large quantities of “yogurt”. He subsequently isolated bacteria from the yogurt and determined that they conferred the observed health-promoting benefits. The clinical evidence for application of the interfering ability of non-virulent bacteria to prevent or treat infections has been rather limited, although promising for certain purposes. Bacterial interference refers to the antagonism between bacterial species during the process of surface colonisation and acquisition of nutrients. Conventionally, probiotics, defined by the WHO as ‘live organisms which, when administered in adequate amounts confer a health benefit on the host’, have almost exclusively been bacteria of intestinal origin, and their application has largely been targeted at relieving maladies of the gastrointestinal tract. A number of relevant preliminary trials suggest that in the upper respiratory tract the rate of recurrence of Streptococcal pharyngotonsillitis appears to decrease using selected bacteria with inhibitory ability against common pathogens of upper respiratory tract. Sore throat is one of the most common reasons for visits to family physicians or paediatrician. URTIs are very common and cause substantial illness and billions of dollars of economic loss every year. Streptococcus pyogenes is a major cause of acute pharyngeal infections, especially in children. Oral probiotic as Streptococcus salivarius K12 has been shown clearly to antagonize the growth of Streptococcus pyogenes, the most important bacterial cause of pharyngeal infections in humans, by releasing two bacteriocins named Salivaricin A2 and Salivaricin B, reducing the incidence of Streptococcal pharyngitis and/or tonsillitis. According to our reviews of the literature and our experience prophylactic administration of Streptococcus salivarius K12 to adults and/or children having a history of recurrent oral streptococcal pathology reduces the number of episodes of streptococcal pharyngeal infections and/or tonsillitis.
- Aging Science
Location: Kuala Lumpur, Malaysia
Chair
Ahmad A Alanazi
University of Arkansas for Medicla Sciences, USA
Session Introduction
Marwa Mohamed Fawzy
Cairo University, Egypt
Title: The utility of stem cells in Alopecia areata: A five year experience
Biography:
Marwa Mohamed Fawzy has completed her PhD from Cairo University and Postdoctoral studies from Cairo University School of Medicine. She is a Professor of Dermatology, Cairo University (since April 2016). She has got International Board Certificate in Dermatopathology (December 2010) passing successfully the 8th International Board Certifying Examination in Dermatopathology. She has published more than 30 papers in reputed journals and has been serving as an Editorial Board Member of repute.
Abstract:
Background: Alopecia areata (AA) is a common condition causing non-scarring hair loss, yet its pathogenesis is still unclear. Treatment of AA is a difficult challenge. The discovery of epithelial stem cells in the bulge region of the outer root sheath of hair follicles in mice and man has encouraged researchers to utilize the hair follicle as a therapeutic source of stem cells for regenerative medicine.
Objective: The objective of the study is to evaluate the use of follicular stem cells in the treatment of AA.
Patients & Methods: Fifteen patients with AA of the scalp were included in a randomized controlled double blinded clinical trial. Isolation of hair follicle stem cells was done by enzymatic digestion of the bulge areas. Cell tagging using iron oxide particles was performed in order to elucidate the exact fate of the injected cells as a way for in vivo cell tracking. Sham saline injections have been done at control sites on the scalp of the treated patients.
Results: Excellent response was achieved in three patients (20%), good response was achieved in seven patients (47%), while five patients (33%) showed poor response at the end of nine months evaluation. None of the placebo injected sites in all included patients showed any response.
Limitations: Sample size is relatively small. Long-term follow up is mandatory.
Conclusion: It can be concluded that, local follicular stem cell therapy could be a feasible, efficient and safe therapeutic option for alopecia areata.
- Head and Neck Oncology
Location: Kuala Lumpur, Malaysia
Session Introduction
Sethu Thakachy Subha
University Putra Malaysia, Malaysia
Title: Recurrent nasopharyngeal carcinoma with axillary lymphnode metastases: A rare presentation
Time : 12:45-1:15
Biography:
Associate Professor Dr.Sethu Thakachy Subha Current Appointment:,Head of Unit ENT Head & Neck Surgery ,Department of Surgery/Otorhinolaryngology Faculty of Medicine & Health Sciences University Putra Malaysia Serdang,Malaysia. Associate Professor Dr.Sethu Thakachy Subha ,obtained her MBBS degree from the University of Kerala India in 1989 and MS degree in ENT Head & Neck Surgery from University Malaya,Kuala Lumpur Malaysia in 2002.she has published articles in local and international peer reviewed journals. She has also presented her research papers in various international conferences. She has been serving as reviewer for many reputed medical Journals.
Abstract:
Nasopharyngeal carcinoma (NPC)representing about 0.7% of global burden of cancers where as NPC is the most common cancer of head and neck in Malaysia,South Eastern China ,Hong kong and Singapore.Nasopharyngeal carcinoma has typically metastases to cervical lymphnodes.Majority(>75%) of NPC patients have advanced locoregional disease with cervical metastases at the time of initial presentation. The common sites of distant metastases are bone,liver,lung and rarely metastases to axillary nodes.We report the rare presentation of recurrent NPC with axillary lympnode metastases.Our patient , 44 years old chinese gentleman who was diagnosed to have NPC with initial staging T2N3bM0 could not complete neoadjuvant chempradiotherapy due to severe oral mucositis.subsequent surveillance assessments were unremarkable and after 3 years he has presented with right axillary lymph nodes.Clinical examination revealed radiotherapy changes at the nasoharynx and absent cervical lymphadenopathy.Fine needle aspiration of nodes showed as metastatic carcinoma.CT scan showed obliteration of right fossa of Rosenmuller and axillary nodes.PET CT demonstarted right supraclacicular , axillary and mediatinal lymphnodes and patient has been subsequently referred for palliative chemotherapy.
Conclusion
This case illustartes the fact that ,eventhough NPC is highly radio and chemo sensitive ,these patients needs close follow up for early detection of recurrence and distant metastases.Despite the effectiveness of radiation and chemotherapy in the mangement of npc ,local or regional failure still occurs.Knowledge of potential mode of spread is not only vital to surgeons and also must be conveyed to patients for self examination.FDG-PET CT is better than CT in detecting residual or recurrent disease in NPC
- Chemical Peels | Head and Neck Oncology
Location: Kuala Lumpur, Malaysia
Chair
Padma Shri Dr. Jitender Mohan Hans
Dr. Hans Centre for ENT, Hearing Care & Vertigo, India
Session Introduction
Masroor Ahmad Wani
Health Zone (Aesthetic & Skin Chamber), India
Title: Application of Chemical peels
Biography:
Masroor Ahmad Wani is Gold Medalist, has done MD from Medical College, Kolkata. He is practicing Aesthetic and Skin Medicine at Health Zone Medicate, Srinagar, India. He has published many articles in newspapers and magazines, has attended more than 22 national and international dermatological conferences.
Abstract:
A chemical peel is used to improve the appearance of the affected skin. A chemical peel solution is applied to the skin that eventually peels off the affected area. The new, regenerated skin is usually smoother and less wrinkled than the old skin. The new skin is temporarily more sensitive to the sun. Three basic kinds of chemical peels are: Superficial peel: Alpha-hydroxy acid or any another mild acid is used to penetrate only the outer layer of skin to gently exfoliate it. The treatment is used to improve the appearance of mild skin discoloration and rough skin as well as to refresh the affected area. Medium peel: Glycolic acid is used to penetrate the out and middle layers of skin to remove damaged skin cells. The treatment is used to improve age spots, fine lines and wrinkles, acne spots, freckles. Deep peel: Phenol or trichloroacetic acid is applied to deeply penetrate the middle layer of skin to remove damaged skin cells. The treatment removes moderate lines, age spots, freckles and shallow scars. Patients feel good improvement in skin appearance. Who is a good candidate for a chemical peel? Generally, fair-skinned and light-haired patients are better candidates for chemical peels. If you have darker skin, you may also have good results, depending upon the type of problem being treated. But you also may be more likely to have an uneven skin tone after the procedure.
Muhammad Sohail
Aga Khan University, Pakistan
Title: Presentation and surgical management of parotid masses at a tertiary care hospital
Biography:
Dr. Awan did his MBBS from Nishtar Medical College in 1990. He did his residency training at Pakistan Institute of Medical Sciences, Islamabad and Aga Khan University Hospital, Karachi and got his post graduate degree (FCPS) from College of Physicians and Surgeons, Pakistan in Otolaryngology and Head and Neck Surgery in 1998. He got his further training in the field of Otology (Ear diseases and surgery) from Wurzberg University, Germany and Portmann Institute, France. Dr. Awan has special interest in Cochlear Implant surgery and started a CI program at AKU in 2005 first of its kind in the country. Dr. Awan has keen interest in research activities and has 50+ national and international publications to his credit. Currently Dr. Awan is working as Associate Professor and Consultant Otolaryngologist at AKUH, he is head of ENT department and also leading the Cochlear Implant Program at Aga Khan University.
Abstract:
Objective: The objective is to analyze the clinical presentation, histopathology, complications and outcomes of parotidectomy.
Material & Methods: Retrospective chart review of 193 patients was performed who underwent parotidectomy from January 2005 to December 2015 at the Aga Khan University Hospital, Karachi. Data collected included age, gender, comorbid, signs and symptom, perioperative facial nerve function, details of surgery, FNA, histopathology and complications.
Results: Out of 193 patients undergoing parotidectomy, 110 (57%) were males and 83 (43%) were females, mean age being 48.21 and 43.76 years respectively. Mean duration of symptoms was 41.33 months and most common symptom was pre-auricular swelling present in all patients followed by pain present in 29 patients (15%) and facial nerve weakness in 6 patients (3.1%). FNAC was performed preoperatively and results were compared with final histopathology. 158 patients (81.86%) underwent superficial parotidectomy while 35 patients (18.14%) underwent total parotidectomy. The final histological diagnosis showed benign lesion in 147 (76.2%) patients and 46 patients (23.8%) had malignant lesions. 23 (11.9%) patients had transient nerve paralysis while 11 (5.7%) had complete facial nerve paralysis after surgery and majority of them were seen after total parotidectomy. Six (3.1%) patients developed post-operative hematoma and 2 (1%) developed Frey’s syndrome. 33 (71.73%) patients were sent for adjuvant radiation therapy out of 46 patients with malignancy and 9 (19.6%) patients with malignancy developed recurrence.
Conclusion: Parotidectomies are performed for almost all parotid masses and are usually associated with good postoperative outcomes. Malignancies of the parotid are rare with most of the masses benign in nature. FNA can prove to be a valuable tool for preoperative counseling of the nature of the disease and prognosis. With modern day procedures facial nerve can be saved in most of the surgical interventions.
Shakeel Uz Zaman
Liaquat National Hospital & Medical College, Pakistan
Title: Predictors of locoregional recurrence in early stage buccal cancer with pathologically clear surgical margins and negative neck
Biography:
Dr. Shakeel Uz Zaman completed his MBBS from King Aga Khan University, Later he joined for specialization of Otorhinolaryngology at Liaquat National Hospital & Medical College, Karachi, Pakistan.
Abstract:
Objective: The purpose of this study was to identify the significant predictors of locoregional recurrence in early stage SCCA of buccal mucosa with pathologically clear surgical margins and negative neck.
Materials & Methods: We retrospectively reviewed records of 73 patients who underwent per oral wide excision and supraomohyoid neck dissection for early stage buccal SCCA between 2007 and 2011 with clear surgical margins (>5 mm margins each) and negative neck (N0). None of the patients received postoperative radiotherapy or chemotherapy. The primary endpoint of the study was local, regional or locoregional recurrence. Univariate and multivariate analyses were used to identify independent predictors of locoregional recurrence.
Results: Recurrence was observed in 22 of 73 (30%) patients at the end of this study. Twelve (54.5%) had local, seven (31.8%) had regional and three (13.6%) developed locoregional recurrences. Sixteen patients (72.2%) had recurrence within the first 2 years of primary treatment. Both univariate and multivariate analyses demonstrated that lymphovascular invasion (LVI) and non-T4 muscular invasion (non-T4MI) were independent predictors affecting locoregional control.
Conclusion: Our results demonstrate that LVI and non-T4MI significantly increased the locoregional recurrence rate in early stage buccal SCCA with clear surgical margins and negative nodal status. Adjuvant treatment with either radiation or chemoradiation should be considered when one or both of these factors present.
Biography:
Mohamed Saleh Elarbi is a renowned Professor in Ali Omar Askar Neurosurgery Centre, Libya. He has many publications to his credit.
Abstract:
Aim: Aim: To review medical records from patients who had maxillofacial infections between january 2008 and January 2016.
Methods: Retrospective analysis of 91 patients ,51 males(56%) and 40 females(44%) admitted in Ali Omar Askar(AOA) University hospital for Neurosurgery ,Oral &Maxillofacial surgery department, Esbea ,Tripoli Libya.
Epidemiology, causes of infection treatment carried out and complications were discussed.
Results:
A total of 91 patients with maxillofacial infection of which 51 were male (56%) , 40 females (44%), 85 patients had Odontogenic infections (93%) , 45 males (52,9%) & 40 females (47,1%)and 6 had non-Odontogenic infections(7%). The Odontogenic infections occurred mostly at the mandible and its associated spaces 74 cases (87%)
Involving the posterior teeth (82%). The main cause was dental caries 80 cases (94%)
The most commonly affected facial anatomic region was the submandibular 39 cases (45,9%)Surgical treatment was required in all the cases.
Conclusions: Maxillofacial infections require proper urgent treatment, to avoid complications, which can be serious. Their Management is primarily surgical (incison ,drinage with extraction of offending tooth as required which require skilled anaesthetic airway management. Immedate admision, monitoring vital signs and high doses of antibiotics ,with intravenous fluids for rehydration .
Early diagnosis and national oral health preventive programme required in all age groups with emphasis on younger age group will reduce the incidence of Odontogenic infections and its serious consequences.
Complications; Mediastinitis, Cavernous sinus thrombosis were reported in two cases.
Keywords: Odontogenic infection, non-Odontogenic;, epidemiology, retrospective analysis.
- Workshop on Ear Surgery
Location: Bunga Anggerik A&B
Session Introduction
Md Monjurul Alam
Bangabundhu Sheik Mujib Medical University, Bangladesh
Title: Initial experience of endoscopic ear surgery in Bangladesh
Biography:
Has been working as Professor of Otolaryngology & Head - Neck Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbag, Dhaka since 2010.
He Passed MBBS from Rajshahi Medical College, FCPS (ENT) from Bangladesh College of Physicians & Surgeon, Qualified MS in Otolaryngology from Dhaka University, obtained FICS from USA.
He got advanced training in Micro-ear Surgery, FESS & Rhyno Plastic Surgery, Snoring & Sleep Surgery, LASER Surgery, Skull-Base surgery from USA, UK, Australia, India, Singapore, Bangkok, Malaysia & different countries of Europe.
He is a pioneer of Endoscopic Ear surgery in Bangladesh. He actively participated in workshop, seminar, conference, Congress in different countries. He has more than 80 articles published in different national & international journals. More than 5 research works has been going on under his supervision in BSMMU.
Abstract:
Background: Endoscopic ear surgery is an emerging technique with recent advancement highlighting advantages over the traditional microscopic approach. In Bangladesh we started doing myringoplasty since 2005 with otoendoscope and stopped due to few problems But again, since 2007, all types of middle ear surgeries with nasal endoscopes has been being done with bright , wide & clear view. We did different types of Transcanal Tympanoplasties, ossicluplasties, stapedotomies, also few cholesteatoma surgeries by endoscope.As Rigid endoscopy allows for wide-field view of the surgical field improved resolution with high magnification, and the ability to look around corners , enabling direct visualization of the hidden recesses including the retrotympanum, epitympanum, supratubal recess, peritympanum and hypotympanum, granulation tissue or cholesteatoma matrix can be removed easily.
Methods: A cross sectional study done during March, 2010 to June,2014 in otolaryngology & Head-Neck surgery dept of Bangabundhu Sheik mujib Medical University (BSMMU) after having permission from Ehethical review board of the University.
Results: During the study period 1200 different types of transcanal Endoscopic Tympanoplasties like underlay & interlay tympanoplasty using different graft matrials ;temporalis fascia,perichondrium, cartilage with graft taken up rate & hearing gain equivalent with tympanoplasty done by microscope. 517 different types ossicluplasties and stapedotomies were done with similar hearing gain done by microscope.117 cholesteatoma surgery – Atticotomy, attico-antrostomy with reconstruction have been done without any major complication or recurrence. Learning curve of surgery among the residents is higher with endoscope.
Conclusions: Endoscopic ear surgery is a new technique that is gaining momentum in Bangladesh and there is enthusiasm for its incorporation into future practice. Further investment in training courses and guidance for those who looking to start or advance the use of endoscopes in their practice will be vital in the the years to come.