Feb 2015 : Report of the Workshop on the Diagnosis of Hirschsprung Disease (HD) and Allied Disorders

St. John's Medical College Hospital, Bengaluru

5th National Hands-on Workshop on the Diagnosis of Hirschsprung Disease (HD) and Allied Disorders

Departments of Pathology & Pediatric Surgery St. John’s Medical College & Hospital, Bangalore

20th and 21st February 2015

Report of the workshop

This Hands-on workshop was organised by the Departments of Pathology and Paediatric Surgery, St. John’s Medical College and Hospital (SJMCH), Bangalore as part of the ANNUAL NATIONAL CME/ WORKSHOP SERIES.

Our registration desks opened at the conference hall of the Silver Jubilee Block at 8.30am on the morning of 20th February 2015. Delegates and faculty came in and the workshop took off with delegates filling the Pre-Test questionnaire. We started with a brief session from 9:00-9:30am on the ‘Introduction to the workshop’ followed by Introduction of faculty, participants and observers from National Academy of Medical Sciences (NAMS) and Karnataka Medical council (KMC). The main objective of the Workshop was to elaborate the main difference that the Hirschsprung team has innovated and simplified in the technique of enzyme and immuno-histo-chemistry of acetylcholinsterase (AChE) histochemical staining of fresh frozen bowel biopsies which is considered to be the most reliable method for accurate determination of microscopic features of Hirschsprung disease. The Hirschsprung Team took this conscious decision in 2010 to spread this technique and its application across the tertiary health care and teaching centres of this country so as to benefit the Indian populace at large

The academic program started with the session on the ‘Clinical features and imaging in Hirschsprung disease/allied disorders by Dr. Kanishka Das, Professor of Pediatric Surgery, SJMCH; from 9:30-10:00am. This was followed by a lecture on the ‘Pathophysiology of Hirschsprung’s disease’ by Dr. Nandeesh B N, Assistant Professor of Pathology, NIMHANS, Bangalore; from 10:00 to 10:20am.

We then had the inaugural program from 10.20 – 10:30am which started with a prayer song by the Nurses from the Pediatric surgery department. Dr. Kanishka Das, the organizing secretary welcomed the gathering and this was followed by the lighting of the lamp. The long awaited Hirschsprung disease website was then launched by Dr. Anura Kurpad, Head of Department of Physiology and former dean of Institute of Population Health and Clinical Research who was the observer from the National Academy of Medical Sciences (NAMS). Vote of thanks was given by Dr. Usha Kini, Chairperson of the workshop. The inaugural program was followed by high tea.

After the tea break, Dr. Namasivayam delivered a session on ‘Manometry in HD/allied disorders’ from 10:40 – 11:00am. During this session relevance of radiological imaging in HD was discussed which was followed by a session on ‘How to take & send rectal/colonic/ileal biopsies: The surgeons’ perspective’ by Dr. Mainak Deb 11:00 to 11:30am.

This was followed by the session on ‘How to receive biopsies for Hirschsprung’s disease / allied disorders the pathologist’s perspective’ by Dr. Usha Kini from 11:30 – 12:00 noon. She continued on to the next session titled ‘Technical problems / issues in AChE staining: handling, orientation and interpretation from 12:00 – 1:00pm. Incorporated into this session were the smaller lectures on ‘A Suitable transport medium for sending fresh biopsies for enzyme histochemistry’ by Dr. Divya P.; and the session on ‘IHC in Hirschsprung’s disease’ by Dr. Maria Bukelo.

The lunch break was from 1:00 to 2:00pm followed by the hands-on part of the workshop from 2:00 to 5:00pm where the delegates were provided with 5 slides having fresh tissue sections and printed handouts having the protocols to do the rapid H&E staining and AChE staining. Also displayed were two case scenarios as a quiz to be discussed on the following day.

Simultaneous live demonstration of processing a fresh biopsy for frozen section was also conducted. The slides from the live demonstration were reported by the delegates and subsequently reporting protocol was discussed. A video demonstration of the ‘Improvised double embedding technique of biopsies’ was conducted by the Lokendra Yadav, through which the delegates were taught how to rapidly process multiple small biopsies at one time. There was also a video demonstration on how to use Rbi-2 to take rectal suction biopsies. The first day of the workshop ended with a Tea break at 5:00pm.

Day two of workshop started at 8:30am with a sumptuous breakfast followed by the first session of the day by Dr. Usha Kini on ‘Classical Hirschsprung disease’ from 9:00-9:45am. This was followed by the session on ‘Low rectal biopsies, Leveling biopsies & the ‘doughnut’ which was jointly taken by Dr. Usha Kini and Dr. Kanishka Das from 9:45 to 10:30am. We then had the lecture on ‘Genetics in HD’ by Lokendra Yadav from 10:30 – 11:00am which was followed by the tea break from 11:00-11:30am.

After the tea break which sparked many discussion we had the session on ‘Hirschsprung’s disease in neonates, Ultra short HD/ Internal anal sphincter achalasia which was jointly taken by Dr. Usha Kini and Dr. Kanishka Das from 11:30 to 12:00 noon. This was followed by the joint session by Dr. Usha Kini and Dr. A M Shubha on ‘Long segment colonic HD, TCA, appendix in HD’ from 12:00 – 12:30pm and the next session by Dr. Usha Kini and Dr. Divya P. on ‘Intestinal Neuronal Dysplasia and hyperganglionosis’ from 12:30 – 1:00pm.

The lunch break was from 1:00-2:00pm following which we had a session on ‘Refractory constipation’ by Dr. Usha Kini from 2:00 to 2:30pm. This was followed by the video demonstration on how to take rectal

biopsies by Dr. Mainak. Dr. Kanishka then described the protocol for managing neonates suspected of HD. From 3:00-3:45pm we had the session on ‘HD mimickers and case scenarios’ by Dr. Usha Kini.

From 3:45-4:30pm the case scenarios which were displayed as a quiz were discussed and a prize was allotted to Dr. Ram Ganesh was getting both the answers right. We also had a session of interaction with the delegates on the various issues they faced pertaining to HD. This was followed by the distribution of certificated to the delegates. The workshop winded up with a Tea break at 5:00pm.

On the whole the session was a great success.