January 25-26, 2018 Seda Vertis North, Quezon...

January 25-26, 2018Seda Vertis North,Quezon City

Vision

Mission

We are the lead national organization committed to the study of the liver in

health and disease, involved in research, education, advocacy and

formulation of national health Policies in partnership with the global

community.

❖ We shall provide and promote comprehensive information to the public

and to the medical community.

❖ We shall promote research to advance the field of hepatology to provide

relevant care to patients.

❖ We shall collaborate with the government in formulating in liver related

health policies.

❖ We shall share information, services and expertise with the global

community towards the prevention and treatment of liver diseases.

PAGES

4 Message from President Rodrigo “ROA” Duterte

5 Message from DOH Secretary

6 Message from the President of Hepatology Society of the Philippines

7 Message from the President of Philippine Society of Gastroenterology

8 Message from the President of Philippine Society of Digestive Endoscopy

9 Message from the Overall Chairman

10 Message from the Scientific Committee Chair

11 HSP Officers and Board of Directors 2017-2018

12-16 2018 HSP Convention Organizing Committee

17 Convention Venue Information

18-21 Detailed Scientific Program

22-28 Foreign Faculty

29-32 State of the Art Speakers

33-44 Local Faculty

45-52 Panelists

53-57 Session Chair and Co-Chair

58-61 Young Investigators Award Research Presentation

62-73 Abstracts

75-87 SPONSORS

My warmest greetings to the Hepatology Society of the Philippines as it holds

it 2018 Philippine Liver Meeting.

Today we recognize your feats and contributions towards the progress of this

community. By gathering leading local and international experts in this

meeting, you provide greater opportunities for growth among our medical

professionals. This would so enrich this highly specialized field and address

concerns related to the research, prevention and treatment of liver diseases.

Through years of change and development, remain to be at the forefront of the

education and empowerment of our physicians. May your endeavors to

advance the practice of hepatology strengthen the government’s resolve to

provide better medical care for our people. Together, let us raise the standard

of excellence as we formulate better health policies for our citizens.

I wish everyone a productive and meaningful event.

RODRIGO ROA DUTERTE MANILA

President of the Republic of the Philippines 25 January 2018

4

5

Dear Colleagues,

Mabuhay!

On behalf of the Hepatology Society of the Philippines, I would like to welcome you to

this year’s scientific convention, which we have named the Philippine Liver Meeting.

Upon perusal of the scientific program, I am certain that everyone will find that the

scientific content satisfies not only the specialists, but also generalists who see and

manage liver cases everyday in their clinics. It is our hope that the lectures, debates and

discussions in the meeting will not only satiate your hunger for knowledge, but also

stir up a desire in you to learn and discover more about the wonderful specialty of

Hepatology!

Finally, it has been said that a leader is only as good as the people that surround

him/her. I truly am blessed to be surrounded by very innovative, competent and

hardworking people led by Dr. Jade Jamias as the overall Chair of the meeting. His

term has truly done a wonderful job in organizing this meeting, which is already a

success story all its own.

So please sit back, relax, and learn.

Sincerely Yours

STEPHEN N. WONG, MD

PresidentHepatology Society of the Philippines

6

Greetings!

On behalf of the Officers and Board of Directors of the Philippine Society of a

Gastroenterology and all its members, I would like to extend my

congratulations to the Hepatology Society of the Philippines for the much

anticipated 2018 Philippine Liver Meeting!

Managing liver disorders remain challenging and rewarding at the same time

and having a venue such as this to discuss, consult and collaborate is always

welcome.

The thought, consideration and care that went into the organization of this

meeting is undeniable and kudos to the Organizing Committee for all the hard

work and effort to promote Continuing Medical Education to all its members.

I look forward to seeing you all at the meeting!

JUDITH D. GAPASIN-TONGCO, MD

PresidentPhilippine Society of Gastroenterology

7

Greetings!

On behalf of the Philippine Society of Digestive Endoscopy, I would like to

welcome you to the 2018 Philippine Liver Meeting. The PSDE fully supports

and endorses this scientific meeting. Spearheaded by the Hepatology Society

of the Philippines, this years event will touch on various liver diseases

ranging from NAFLD, hepatitis, cirrhosis and liver cancer. Expert faculties

both local and international will discuss updates in the diagnosis and

treatment of this conditions.

I hope we learn and apply the knowledge we get from this scientific meeting.

Ultimately this will be for the benefit of our patients who always rely on us

for updated information and guidance on their illness.

Thank you very much. See you there!

DENNIS A. ONA, MD, FPSG, FPSDE

PresidentPhilippine Society of Digestive Endoscopy

8

Dear Colleagues,

Greetings!

This year marks the 12th year of the Hepatology Society of the Philippines (HSP) and as

we face and move forward to the coming years, we thought of creating a “signature

name” for our biennial scientific meeting, which is the PHILIPPINE LIVER

MEETING. This name will hopefully confer a distinct identity to our meeting similar to

our international counterparts.

The scientific committee headed by the very able, Dr. Janus Ong prepared a very

interesting and up to date topics which are not only relevant to liver specialists and

gastroenterologists but to the general practitioners as well. Apart from the usual didactic

lectures on various aspects of liver cirrhosis and liver diseases, there will be

multidisciplinary case discussions and debates on some of the controversial issues to

make the discussion more stimulating and attention-grabbing to our delegates. Rest

assured the next two days will be both enriching to our minds and entertaining to our

Ids.

On behalf of the organizing committee, it is my great honor and pleasure to welcome

you all to the 2018 Philippine Liver Meeting.

Let me end by saying, ” ANG HSP ANG TUNAY NA KAAGAPAY SA MGA

USAPING PATUNGKOL SA ATAY”.

Sincerely,

JADE D. JAMIAS, MD, FPCP, FPSG, FPSDE

Vice President, Hepatology Society of the PhilippinesOverall Chairman, HSP 2018 Philippine Liver Meeting

9

Greetings!

On behalf of the scientific committee, I would like to invite you to join us at the

2018 Philippine Liver Meeting to be held on January 25-26, 2018 at the SEDA

Vertis North, Quezon City.

The Philippine Liver Meeting, organized by the Hepatology Society of the

Philippines, aims to present a comprehensive program that will cover the breadth

of Clinical Hepatology. The scientific committee has worked hard to come up

with a scientific program that is both timely and relevant to the care of patients

with liver disease in 2018.

International and local experts have been invited to tackle the latest advances in

the diagnosis and management of Nonalcoholic Fatty Liver Disease, Hepatitis B,

Hepatitis C, Hepatobiliary Malignancies, and the various complications of

cirrhosis such as coagulopathy, hepatopulmonary syndrome, and sarcopenia.

Aside from the traditional lecture format, there will be clinical debates on

controversial topics and multidisciplinary panel discussions on complex

hepatobiliary diseases.

I look forward to your active participation in the meeting. See you at the

Philippine Liver Meeting!

JANUS P. ONG, MD

Scientific Committee HeadHSP 2018 Philippine Liver Meeting

Stephen N. Wong, MD

President

Jade D. Jamias, MD

Vice President

Arlinking K. Ong-Go, MD

Secretary

Roberto N. De Guzman Jr., MD

TreasurerJane Ricaforte-Campos, MD

P.R.O.

Wendell Z. Espinosa, MD

Board of DirectorEdhel S. Tripon, MD

Board Of Director

Angela D. SalvaÑa, MD

Board Of Director

Ian Homer Y. Cua, MD

Immediate Past President 10

12

JADE D. JAMIAS, MDOverall Chairman, HSP 2018 Organizing CommitteeVice President, Hepatology Society of the Philippines

13

Janus P. Ong, MD

Head Committee

Joseph C. Bocobo, MD Eternity D. Labio, MD Edhel S. Tripon, MD Arlinking K. Ong-Go,

MD

Angelo B. Lozada, MD

Roberto N. De Guzman Jr.,

MD

Head Comm.

Ruth Ursula C. Cinco, MD

Head Comm.

Eda Jo D. Amatong, MD

Member

14

David M. Banayo, MD

Head Committee

Conrado B. De Castro, MD Christopher Sampana, MD

Denis C. Ngo, MD

Head Comm.

MEMBERS:Angela D. Salvaña,

MD

Head Comm.

Karl Yu Kim Teng, MD

Flor M. Maramag,

MD

Member

Eric Yasay, MD

MEMBERS:

Marie Ellaine N. Velasquez, MD

15

Anne Marie Geraldine J. Javier, MD

Head Committee

Milben A. Malbog,

MD

Shayne G. Villafuerte, MD

Marilyn Talingdan-Te, MD

Head Comm.Don Izzy T. Yee, MD

MemberMEMBERS:

Edward L. Lim, MD

Head Comm.

16

VENUE SEDA Vertis North, Quezon City

SPECIAL EVENTS

Opening Ceremony 25 Jan. 2018 10:15-10:45am Plenary

Fellowship Night 26 Jan. 2018 8:00pm Plenary

REGISTRATION

Registration counters are located at the 2nd Floor near stair way area and will be opened as follows:

* 25 Jan 2018 07:00-08:00 am

* 26 Jan 2018 07:00-08:00 am

BADGES All delegates are required to wear their name badges at all times during the convention.

CONVENTION EVALUATION SHEET will be submitted at the registration area.

All delegates are invited to visit the booths with interesting and relevant information on display. The booth for the gold

sponsors are located at the Foyer Area The rest of the booths are located at the Function Rooms.

LIABILITIES The Organizing Committee shall not be liable for personal accidents, loss or damage to private property

belonging to convention delegates during the convention. Delegates should make their own arrangements with respect to

personal insurance.

DISCLAIMER While every attempt would be made to ensure all aspects of the convention mentioned in the

announcement will take place as scheduled, the Organizing Committee reserves the right to make any last minute changes

should the needs arise without prior notice.

TIME DAY 1 (Thursday) SPEAKER

07:00-08:00AM REGISTRATION

NAFLD

Chair: Jaime G. Ignacio, MD

Co-Chair: Wendell Z. Espinosa, MD

08:00-08:20AM Human Gut Microbiome: Its Implications in Liver Disease IAN HOMER Y. CUA, MD

08:20-08:40AM Lifestyle Modification in NAFLD: Practical Tips MICHAEL CHARLTON, MD

08:40-09:00AM NAFLD as a Systemic Disease: Its Implications on Management VINCENT WONG, MD

09:00-09:15AM OPEN FORUM

09:15-10:15AM MID-MORNING SYMPOSIUM ( MYLAN )

10:15-10:45AM OPENING CEREMONY

10:45-11:15AM STATE OF THE ART LECTURE I

Treatment of Chronic Hepatitis B: Beyond Virologic Suppression

Chair: Judith Gapasin-Tongco, MD

VINCENT WONG, MD

11:15-11:45AM STATE OF THE ART LECTURE II

Pathogenesis of Hepatosplenic and Subtle Morbidities in

Schistosomiasis japonica

Chair: Erlinda V. Valdellon, MD

REMIGIO M. OLVEDA, MD

11:45-1:15PM LUNCH SYMPOSIUM ( GETZ )

17

TIME DAY 1 ( Thursday ) SPEAKER

VIRAL HEPATITIS

Chair: Leticia T. Ibañez-Guzman, MD

Co-Chair: Mark Anthony A. De Lusong, MD

1:15-1:35PM Isolated Anti-HBc: Implications for Liver Disease and Management DIANA A. PAYAWAL, MD

1:35-1:55PM WHO Guidelines on Hepatitis B and C testing:

Distilling the Details for Local Use

JOSE D. SOLLANO JR., MD

1:55-2:15PM Antiviral Therapy In Difficult-To-Treat HCV Populations: Genotype 3,

Decompensated Cirrhosis, CKD, and Patients Eligible for Liver Transplant

PROF. HAMID SAEED

2:15-2:30PM OPEN FORUM

2:30-2:45PM COFFEE BREAK/VISIT THE EXHIBIT

2:45-3:45PM MID-AFTERNOON SYMPOSIUM ( MENARINI )

3:45-4:15PM Debate: Locally Advanced HCC (BCLC C with PVT and no extra hepatic

mets): Locoregional Therapy or Sorafenib?

Chair: Evelyn B. Dy, MD

Co-Chair: Dennis A. Ona, MD

STEPHEN N. WONG, MD

JENNY L. LIMQUIACO, MD

4:15-5:15PM

Management of AOCLF In The ICU:

A Multidisciplinary Discussion

Moderator: JANUS P. ONG,

MD

Discussants:

Eternity D. Labio, MD

Emily Aventura, MD

Roberto Tanchanco, MD

Vanessa De Villa, MD

Cybelle Abad, MD

5:15-6:45PM SUNSET SYMPOSIUM ( HI-EISAI ) 18

19

TIME DAY 2 ( Friday ) SPEAKER

07:00-08:00AM REGISTRATION

CIRRHOSIS

Chair: Ernesto G. Olympia, MD

Co-Chair: Estrellita J. Ruiz, MD

08:00-08:20AM The Rational Use of Albumin in Cirrhosis ANGELA D. SALVAÑA,

MD

08:20-08:40AM Cardiac and Pulmonary Complications of Cirrhosis: Recognition and

Management

EDHEL S. TRIPON, MD

08:40-09:00AM Sarcopenia in Cirrhosis: Causes, Implications and Management JADE D. JAMIAS, MD

09:00-09:20AM Coagulopathy in Liver Disease – Monitoring, Therapies and Indications for

Blood Products

TERESITA E. DUMAGAY,

MD

09:20-9:35AM OPEN FORUM

9:35-10:35AM MID-MORNING SYMPOSIUM ( SIRTEX )

10:35-10:50AM COFFEE BREAK / VISIT EXHIBIT

10:50-11:20AM STATE OF THE ART LECTURE III

Current Status Of Organ Donation In the Philippines

Chair: Dina C. Gonzales, MD

FRANCIS ESCUETA

SARMIENTO III, MD

11:20-12:50PM LUNCH SYMPOSIUM ( BAYER )

20

TIME DAY 2 ( Friday ) SPEAKER

HEPATOBILIARY MALIGNANCY

Chair: Marichona C. Naval, MD

Co-Chair: Albert E. Ismael, MD

12:50-1:10PM Combined Hepatocellular - Cholangiocarcinoma: Recognition,

Diagnosis and Management

YI-HSIANG HUANG, MD, PhD

1:10-1:30PM The Emerging Conundrum of Hepatocellular Carcinoma and DAA

Therapy for HCV

PROF. JIA-HORNG KAO

1:30-1:50PM Treatment of Intermediate HCC (BCLC B):

Surgery, Locoregional Therapy, or Systemic Thearpy

PROF. STEPHEN LAM CHAM

1:50-2:05PM OPEN FORUM

2:05-3:05PM MID-AFTERNOON SYMPOSIUM ( KAUFMANN )

3:05-3:50PM RESEARCH SYMPOSIUM

3:50-4:05PM COFFEE BREAK/VISIT EXHIBIT

4:05-4:35PM Debate-Non-Neoplastic Protal Vein Thrombosis in Cirrhosis:

Anticoagulate or not?

Chair: Frederick T. Dy, MD

Co-Chair: Marie Michelle S. Cloa, MD

JUDY Y. LAO-TAN, MD

MARILYN O. ARGUILLAS, MD

4:35-5:35PM The Patient With A Hilar Mass: A Multidisciplinary Discussion Moderator:

ARLINKING K. ONG-GO, MD

Discussants:

Evan G. Ong, MD, Billy Uy, MD

Denky Dela Rosa, MD

Roy Habito, MD

5:35-7:05PM SUNSET SYMPOSIUM ( INNOGEN )

7:05PM FELLOWSHIP NIGHT

22

Medical School: Charing Cross and Westminster Medical

School, University of London, England

Training: Residency, Internal Medicine,

Fellowship, Gastroenterology and Hepatology

University of Vermont, Burlington, Vermont

Fellowship Hepatology and Liver Transplant,

Mayo Clinic

Board Certified in Internal Medicine, Gastroenterology and Hepatology, and

Transplant Hepatology

Professor of Medicine, Director Transplant Institute and Center for Liver

Diseases, University of Chicago Biological Sciences

Associate Editor, American Journal of Transplantation

Research Interests include Transplant Immunosuppression, Hepatitis C,

Metabolic Diseases, NAFLD

23

Medical School: The Chinese University of Hong Kong

Training: Residency in Internal Medicine,

Fellowship in Gastroenterology and Hepatology,

The Chinese University of Hong Kong

Professor, Department of Medicine and Therapeutics,


Former President (2015-2017), Hong Kong Association Study for Liver

Diseases

Associate Editor, Clinical Gastroenterology and Hepatology

Research Interests include Viral Hepatitis, Non-Alcoholic Fatty Diseases

24

Medical School College of Medicine, National Yang-Ming University,

Taipei, Taiwan

Training Postdoctoral Fellow, Vaccine Branch, National

Cancer Institute, National Institute of Health,

Bethesda, MD, USA

Chief, Division of Gastroenterology & Hepatology, Department of Medicine,

Taipei Veterans, General Hospital, Taipei, Taiwan

Director, Department of Internal Medicine, Faculty of Medicine, National

Yang-Ming University School of Medicine, Taipei, Taiwan

Professor Institute of Clinical Medicine, National Yang-Ming University

School of Medicine, Taipei, Taiwan

Editorial Board, PLoS One, Liver International, Advances Indigestive Medicine

25

Medical School King Edward Medical College, Lahore

Training Clinical Research Fellow, Gastroenterology, John

Radcliff Hospital, University of Oxford, Oxford UK

Fellowship Hepatology, Liver Unit, South Western Medical

School, University Texas, Dallas

The Ibn-e-Sina Chair and Professor Consultant Gastroenterologist,

Department of Medicine, The Agkhan University and Hospital, Karachi,

Pakistan

Editorial Board, Hepatology International, World Journal of

Gastroenterology, Journal Gastroenterology and Hepatology and

many others

26

Medical School College of Medicine, National Taiwan

University, Taiwan

Training Residency in Internal Medicine, National

Taiwan Hospital

Fellowship in Gastroenterology and

Hepatology, Taiwan University Hospital

National Chair Professor, Ministry Education, Taiwan

Distinguished Professor at the Graduate Institute of Clinical

Medicine, College of Medicine, National Taiwan University

Hospital

Director Division of Hepatology and Gastroenterology, National

Taiwan University Hospital

President Taiwan Association for the Study of the Liver

Fellow American Association for the Study of the Liver

Diseases

Editor in Chief, Journal of Formosan Medical Association

27

Medical School The Chinese University of Hong Kong

Associate Professor, Department of Clinical Oncology, The Chinese

University of Hong Kong

International Member, National Cancer Institute (NCI)

Hepatobilliary Task Force

Editorial Board, Liver International and Asia-Pacific Journal of

Clinical Oncology

Gold Medal for Dissertation (2007) and Young Investigator Award

(2008) from Hong Kong College of Physicians

Research Interest include Clinical and Translation Research in

Hepatocellular Carcinoma

29

Medical School: The Chinese University of Hong Kong

Training: Residency in Internal Medicine,

Fellowship in Gastroenterology and

Hepatology, The Chinese University of

Hong Kong

Professor, Department of Medicine and Therapeutics,


Former President (2015-2017), Hong Kong Association Study for

Liver Diseases

Associate Editor, Clinical Gastroenterology and Hepatology

Research Interests include Viral Hepatitis, Non-Alcoholic Fatty

Diseases

30

Diplomate in Internal Medicine and a Fellow of the Philippine College of

Physicians and Philippine Society of Gastroenterology.

Director, Research Institute for Tropical Medicine, Department of Health,

Philippines, 1993 to 2013.

Member, National Academy of Science and Technology

Pioneering work in Schistosomiasis research

• Worked simultaneously in both basic science laboratory research, field

research, and translational research in the study of Schistosomajaponicum

• First to use portable ultrasound to define liver pathology induced by

Schistosoma japonicum• Early investigator in the field of “Subtle Morbidity,” which changed the

approach to schistosomiasis control from treating only heavy infected

individuals to population-based mass chemotherapy

• First to show the impact of Schistosomiasis on growing children during

the adolescent growth spurt as well as the impact of the Far Eastern strain

of schistosomiasis on anemia

• Collective work has been critical to the worldwide schistosomiasis

control efforts and has guided the Schistosomiasis Control Program in the

Philippines for decades.

31

Medical School, College of Medicine, University of the Philippines,

Manila

Recipient, Certificate on the Gender, Reproductive Health and Fertility module

under The Amsterdam Masters in Medical Anthropology from the Universiteit van

Amsterdam in The Netherlands.

Programme Manager, United Nations Development Program's International Open

Source Network for the ASEAN, 2006 to 2009

Executive Assistant, Office of the President and CEO, Philhealth, 2011 to 2015

Completed Transplant Procurement Management-Advanced International

Training Course in Transplant Coordination

Presently, Program Manager, Philippine Network for Organ Sharing (PhilNOS)

and Philippine Organ Donation and Transplantation Program (PODTP)

Dr. Sarmiento is pursuing his master's degree in Health Informatics (Medical

Informatics track) at the University of the Philippines in Manila.

33

Training Internal Medicine Residency at St. Luke’s

Medical Center Quezon City

Gastroenterology Fellowship at St. Luke’s

Medical Center Quezon City

Post-fellowship training in:

* Hepatology at Storr Liver Unit, Westmead

Millenium Institute, University of Sydney

at Westmead Hospital

*Interventional Hepatology at Chang Gung

Memorial Hospital, Linkou, Taiwan;

*Transplantation Hepatology at the Center for

Liver Disease and Transplantation, New York

Presbyterian Hospital, Columbia University,

Medical Center, USA

Immediate Past President, Hepatology Society of the

Philippines

Assistant Head of the St. Luke’s Liver Disease and Transplant

Center-Bonifacio Global City

34

Medical School Faculty of Medicine and Surgery of the

University of Sto. Tomas

Training Gastroenterology and Digestive Endoscopy,


Hepatology, Interventional Sonology and

Digestive Endoscopy

University of Tokyo

Clinical Associate Professor of the Department of Medicine,


Past President of Philippine Society of Gastroenterology and

Hepatology Society of the Philippines

Board Regent, Philippine College of Physicians

35

Medical School University of Santo Tomas

Training Gastroenterology Fellowship from the

University of Santo Tomas Hospital

Professor of Medicine, University of Santo Tomas College of

Medicine & Surgery

Past President of the Philippine Society of Gastroenterology,

Digestive Endoscopy, Hepatology Society of the Philippines,

Philippine College of Physicians and Asia Pacific

Association for the Study of the Liver (APASL)

Member, Chronic Hepatitis B Global Guidelines Task Force of

the World Gastroenterology Organization (WGO)

36

Medical School University of Santo Tomas, Bachelor

of Science Major in Biology “Accelerated

program “ 1991-93, Doctor of Medicine

1994-97 Graduated “cum laude”

Training Internal Medicine, University of

Santo Tomas

Fellowship in Gastroenterology,

University of Michigan (Ann Arbor,

MI USA) Clinical Hepatology,

Chang Gung Memorial Hospital

(Linkou, Taiwan R.O.C.)

Fellowship in Interventional

Hepatology (Radio frequency

ablation & Ethanol injection of liver

tumors)

President, Hepatology Society of the Philippines

37

Medical School Cebu Institute of Medicine

Training Internal Medicine at Chong Hua Hospital,

Cebu

Gastroenterology Fellowship at

Philippine General Hospital

Clinical Hepatology at Prince of Wales

Hospital HK

RFA/Interventional Hepatology at Chang

Gung Memorial Hospital, Taiwan

Assistant Professor IV – Cebu Institute of Medicine

Clinical Tutor – Cebu Doctors University Hospital

Section HEAD of Gastroenterology and Endoscopy, University of

Cebu Medical Center and St Vincent General Hospital

Member, Hepatology Society of the Philippines

38

Medical School University of the Philippines,

College of Medicine

Training Internal Medicine Residency

Medical College of Wisconsin

Gastroenterology Fellowship at the


Hepatology Fellowship at

University Hospitals of Cleveland

Clinical Associate Professor at the UP College of Medicine

Board Member, Hepatology Society of the Philippines

Member, Philippine Society of Gastroenterology abd Philippine

Society of Digestive Endoscopy

39

Medical School University of the Philippines College

of Medicine

Training Internal Medicine, University of the

Philippines-Philippine General

Hospital

Fellowship Gastroenterology and

Digestive Endoscopy, University of

the Philippines-Philippine General

Hospital

Clinical fellowship in Hepatology,

National University Hospital

Singapore

Medical Specialist, Bulacan Provincial Hospital

Board Member, Hepatology Society of the Philippines

40

Medical School University of Sto. Tomas, Faculty

of Medicine and Surgery

Training Gastroenterology and Digestive

Endoscopy at the UP-PGH

General Hepatology and Liver Transplant

Medicine at the AW Morrow

Gastroenterology and Liver Centre in

Sydney, Australia

Past Training Officer, Department of Internal Medicine at the

National Kidney and Transplant Institute

Vice President, Hepatology Society of the Philippines

41

Training Internal Medicine, UP-PGH

Fellowship Training in Adult Hematology,

UP-PGH, (Chief Fellow)

Observership in Blood and Marrow

Transplantation

Kelo University Hospital,

Institute of Medical Sciences University

of Tokyo,

National Cancer Center, Hospital Tokyo

Affiliations/Appointments:

* Fellow of the Philippine College of Physicians

* Diplomate of the Philippine Society of Hematology

and Blood Transfusion

* Member, Philippine Society of Blood and Marrow

Transplantation

Member, Philippine Medical Association

Presently, Associate Clinical Professor, UP PGH,

Active Consultant, Medical Center Manila,

Active Consultant, Manila Doctors Hospital

42

Medical School Cebu Institute of Medicine

Training Fellowship in Gastroenterology at the UP


Earned Master of Arts in Teaching Related

Sciences from the Cebu Doctors Hospital

Founding member, Hepatology Society of the Philippines

Past Chairperson of the Department of Medicine at the Chong Hua

Hospital

Served as Member of the Board of Directors of the Philippine

Society of Gastroenterology and Hepatology Society of the

Philippines

43

Medical School University of the Philippines,

College of Medicine

Training Fellowship in Gastroenterology at

the UP- Philippine General Hospital

Served as a member of the Board of Directors of the Philippine Society

of Gastroenterology and the Hepatology Society of the Philippines

Past President of the Hepatology Society of the Philippines

Past Exec. Council, Asian Pacific Association for the Study of the

Liver (APASL)

Emily Aventura, MD

Roberto Tanchanco, MD

Cybele Abad, MD

46

Eternity D. Labio, MD

Vanessa H. De Villa, MD

47

Medical School University of the Philippines, College of

Medicine

Training Fellowship, Gastroenterology at the UP-


Fellowship, Hepatology and Liver

Transplantation at the Royal Prince Alfred

Hospital, University of Sydney, Australia

Past President, Hepatology Society of the Philippines (HSP)

Active Consultant, Medical City, Asian Hospital and Makati Medical

Center

48

Medical School University of the Philippines, College of

Medicine

Training Doctoral Studies at the Faculty of

Medicine, University of Navarre, Spain

Fellowship, Liver Surgery and Liver

Transplantation at Chang Gung Memorial

Hospital in Kaohsiung, Taiwan

Worked with the Hepatobiliary and Liver Transplantation Division of

the Department of Surgery of the University of Hong Kong, Queen

Mary Hospital

Fellow of the Philippine College of Surgeons, the Philippine Society

for Transplant Surgeons

Chair of the Philippine Board of Transplant Surgery

Director of the Center for Liver Disease Management and

Transplantation at The Medical City

Member, Hepatology Society of the Philippines

49

Medical School : University of the East Ramon Magsaysay Memorial Medical

Center

Training: Residency in Internal Medicine, Philippine General

Hospital

Fellowship in Nephrology, Philippine General

Hospital

International Fellowship in Nephrology, Cleveland

Clinic in Ohio, USA

Masters in Business Administration, Ateneo Graduate

School of Business

Affiliations:

Fellow, Philippine College of Physicians

Fellow, Philippine Society of Nephrology

Presently,

\ President, Philippine Society of Nephrology

Head, Section of Nephrology of the Department of Medicine The Medical

City

Consultant Director of the Transplantation Program The Medical City

50

Medical School: University of Sto. Tomas, Manila Philippines

Training:

Internal Medicine, Louisiana State University Health Sciences Center

New Orleans, Louisiana

Fellowship, Pulmonary Critical Care Medicine

Louisiana State University Health Sciences Center/

Ochsner, Clinic Foundation, New Orleans, Louisiana

Affiliations:

Philippine College of Chest Physicians

Diplomate, American Board of Internal Medicine Critical Care

Certification

Diplomate, American Board of Internal Medicine Pulmonary Disease

Certification

51

Medical School: University of the Philippines College of Medicine

Training:

Residency in Internal Medicine, Rush University Medical Center

Chicago, Illinois USA

Fellowship in Infectious Disease

University of Wisconsin School of Medicine and Public Health

Madison, Wisconsin USA

Transplant Infectious Disease

Mayo Clinic Rochester, Minnesota

Affiliations:

Fellow, Philippine College of Physicians

Fellow, Infectious Disease Society of America

Member, American College of Physicians

Member, Society for Healthcare Epidemiology of America

Presently,

Chair, Infection Control Committee

The Medical City

Roy Habito, MDBilly James Uy, MD

Evan G. Ong, MD Denky Shoji Dela Rosa, MD

53

54

Medical School University of the East Ramon Magsaysay

Memorial Medical Center

Training Residency in Internal Medicine

University of the East Ramon Magsaysay


Oncology Fellowship training at Philippine

General Hospital

Associate Professor at University of the East Ramon Magsaysay


Affiliated with St. Luke’s Medical Center Bonifacio Global City

55

Medical School: University of Santo Tomas College of Medicine

Training:

Fellowship, Gastroenterology

University of Santo Tomas College of Medicine

Fellowship, Advanced Therapeutic Endoscopy, Department of

Endoscopic Surgery,

University of Hamburg

Past President, Philippine Society of Digestive Endoscopy

Current Appointment:

Section Head of Gastroenterology, Metropolitan Hospital

56

Medical School: Doctor of Medicine, Magna Cum Laude

University of Santo Tomas

Training: Residency in General Surgery

Chinese General Hospital and Medical Center

Fellowship in Hepato-Biliary and PancreaticSurgery

Seoul National University Bundang Hospital, South Korea

Affiliations: Fellow, Philippine College of Surgeons

Fellow, Philippine Society of General Surgeons

Fellow, Philippine Association of Laparoscopic and

Endoscopic Surgeons

Fellow, Philippine Association of Hepato- Pancreato- Biliary

Surgery

Academic Appointment:

Assistant Professor II, Department of Physiology

Manila Central University- Filemon D. Tanchoco Medical

Foundation

57

Medical School: University of the Philippines College of Medicine

Training:

Residency in Diagnostic Radiology

University of the Philippines- Philippine General Hospital

Clinical Fellow, Vascular and Interventional Radiology, Nuclear

Medicine and Molecular Imaging, Abdominal Imaging and Interventional

Radiology

Massachusetts General Hospital/Harvard Medical School

Current Appointments:

Chairman, Department of Radiology

The Medical City, South Luzon

Technical Consultant, Center for Device Regulation, Radiation

Health and Research, Food and Drug Administration, Department of

Health, Philippines

2016 Balik Scientist Awardee, Department of Science and

Technology, Philippines

Associate Editor, Frontiers in Oncology, Lausanne, Switzerland

Jaime G. Ignacio, MD

Chair

Wendell Z. Espinosa, MD

Co-Chair

Leticia T. Ibañez-Guzman, MD

Chair

Mark Anthony A. De Lusong, MD

Co-Chair

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Dina C. Gonzales, MD

State of the Art Chair

Erlinda V. Valdellon, MD


Judith D. Gapasin-Tongco, MD


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Evelyn B. Dy, MD

ChairFrederick T. Dy, MD

Chair

Co-Chair

61Dennis A. Ona, MD

Co-ChairMarie Michelle S. Cloa, MD

Co-Chair

Ernesto G. Olympia, MD

Chair

Estrellita J. Ruiz, MD

Co-Chair

Marichona C. Naval, MD

Chair

Albert E. Ismael, MD

Co-Chair62

64

Prevalence of NAFLD Among Patients with Pre-diabetes Mellitus at the Out-patient Clinics

65

Predictors for Refractoriness to Transarterial Chemoembolization AmongHepatocellular Caner Patients. A Ten Year Single Center Study

66

Radiofrequency Ablation of Liver Metastasis from Colorectal Cancer with or without Chemotherapy Leads to Better

68

Human Gut Microbiome: Its Implication in Liver Disease

Ian Homer Y. Cua, MD

Gut microbiota changes are important in determining the occurrence and

progression of chronic liver disease related to alcohol, nonalcoholic fatty liver

disease, and cirrhosis. Specifically, the systemic inflammation, endotoxemia, and

the vasodilation that leads to complications such as spontaneous bacterial

peritonitis and hepatic encephalopathy could be related to the gut milieu. Given the

poor prognosis of these events, their prevention and early management are

essential. Microbiota may be an essential component of the gut milieu that can

impact these clinical events. Recent human and animal studies have shown that the

relative abundance and the functional changes of microbiota in the stool, colonic

mucosa, and saliva have varying consequences on the presence and prognosis of

chronic liver disease and cirrhosis. The impact of therapies on the microbiota is

slowly being understood and will likely lead to a more targeted approach to gut

microbiota modification in chronic liver disease and cirrhosis.

69

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease

worldwide, affecting a quarter of the Asian adult population. In Western countries, NAFLD, especially

nonalcoholic steatohepatitis (NASH), has already become one of the leading causes of end-stage liver

disease and hepatocellular carcinoma.

It is well recognized that NAFLD is strongly associated with all components of the metabolic

syndrome. In particular, even among patients with normal fasting blood glucose, postprandial

hyperglycemia is common, and insulin resistance is almost universal. The diagnosis of NAFLD may

also predates the diagnosis of diabetes for several years. Along the same line, cardiovascular

disease, chronic kidney disease and extrahepatic malignancies have all been reported to be more

common among NAFLD patients. The association is even stronger in patients with NASH or advanced

fibrosis.

Nonetheless, it is important to highlight that association is not the same as causation. With a few

exceptions, NAFLD has not been proven to be the cause of the systemic disorders. While lifestyle

modification is expected to benefit both NAFLD and the other metabolic disorders, it is unclear if a

NASH-specific treatment (4 drugs have entered phase 3 development) will impact on the associated

disorders. In any case, since the association between NAFLD and metabolic diseases and

complications is strong, hepatologists should recognize NAFLD as a systemic disease and provide

optimal care for the metabolic diseases. In addition, colorectal cancer screening should be

recommended because it is one of the obesity-related cancers and screening has been shown to save

lives.

NAFLD as a systemic disease: Its implications on management

Prof. Vincent Wong

70

Chronic hepatitis B affects around 248 million individuals globally and is the leading cause of

end-stage liver disease and hepatocellular carcinoma in most Asian countries. The development

of oral nucleos(t)ide analogs (NAs) in the late 1990s has revolutionized the management of

chronic hepatitis B. Currently, the use of entecavir and tenofovir disoproxil fumarate (TDF) can

lead to hepatitis B virus (HBV) DNA suppression, alanine aminotransferase normalization,

hepatitis B e antigen seroconversion (HBeAg) and histological improvement with a low risk of

drug resistance.

Nevertheless, because NAs suppress but do not eliminate HBV, many patients require long-term

treatment. According to current guidelines, HBeAg-positive patients may stop NAs after

sustained HBeAg seroconversion and HBV DNA suppression. The optimal management for

HBeAg-negative patients with complete viral suppression by NAs is elusive. While virologic

relapse is very common after treatment cessation, some small case series suggest that such

relapse may be followed by hepatitis B surface antigen (HBsAg) seroclearance in some patients.

As the current NAs are already very good at suppressing HBV, our next goal should be function

cure as represented by HBsAg seroclearance. Peginterferon alfa-2a is another treatment option

for chronic hepatitis B. Compared with NAs, peginterferon can clear intrahepatic covalently

closed circular DNA (cccDNA). Peginterferon-induced HBeAg and HBsAg seroclearance is also

more durable. A few groups have tried to add peginterferon in patients with HBV DNA suppressed

by NAs with varying success. Even so, it is unlikely that peginterferon treatment with and without

NAs can result in HBsAg seroclearance in more than 20% of patients.


Prof. Vincent Wong

71

A number of new agents have now entered phase 1 to 2 development with the aim of

achieving HBsAg seroclearance or at least durable off-treatment response. The new

treatments can be broadly divided into direct-acting antivirals and host-targeting

agents. Early studies on capsid inhibitors and small interfering RNA have already

shown some effects on HBV DNA and HBsAg levels. Data on more meaningful

endpoints and durability are eagerly awaited.


Prof. Vincent Wong

72

Morbidities in schistosomiasis are grouped into those with clear end-organ complications and those

with subtle manifestations. In the hepatosplenic form of schistosomiasis japonica and mansoni, lesions

around the eggs trapped in the pre-sinusoidal areas of the liver start as eosinophilic infiltrates around

the ova. A granuloma eventually develops around the ova and over time, the ova inside degenerate and

calcify. Eventually, granulomas are replaced by surrounding fibrous tissue formation. The mechanisms

involve in granuloma formation and fibrosis in the liver have been documented extensively. Th1 cells

response predominate in the early phase followed by Th2 cells response in the late stage of the

granuloma formation. Towards the end stage of granuloma formation, the fibroblasts are stimulated by

egg products and by T lymphocyte cytokines to proliferate, replace most of the cellular elements, and

mediate fibrotic collagenous material deposition around the portal vein tributaries. Severe fibrosis

causes portal vein obliteration leading to the development of portal hypertension and lethal

complications. On the other hand, inflammatory cytokines induced by eggs or worm products are

responsible for the pathogenesis of subtle morbidities like growth retardation, malnutrition and

impaired cognitive functions in children and poor pregnancy outcomes. Production of inflammatory

cytokines such as TNF-, IL-6, and IFN- have been suggested as the basis through which S. japonicum

may lead to poor linear growth and under-nutrition. For adverse birth outcomes associated with

maternal schistosomiasis direct infection of the placenta or female reproductive tract is not the primary

mechanism involve but more by systemic effects of infection mediate both by extra-placental and

placental processes. The mechanisms involve in the development of schistosome induced anemia are 4

not 2. They are: (1) iron deficiency due to extra-corporeal loss; (2) splenic sequestration; (3)

autoimmune hemolysis; and (4) anemia of inflammation.

State of the Art Lecture: Pathogenesis of Hepatosplenic and

Subtle Morbidities in Schistosomiasis japonica and mansoni

Remigio M. Olveda, MD, FPCP, FPSG

73

The Rational Use of Albumin in Cirrhosis

Angela D. Salvaña, MD

Human serum albumin undergoes quantitative, structural and functional

changes in cirrhosis, affecting common clinical complications of

cirrhosis. This session discusses the changes in albumin associated

with ascites, hepatorenal syndrome and septic shock in cirrhosis.

Practical pointers for use of albumin will also be discussed.

74

Cirrhotic patients may undergo important changes in their cardiovascular and pulmonary

physiology in the setting of portal hypertension. These changes may lead to deterioration in the

quality of life and increased morbidity and mortality pre and post liver transplant. Cirrhotic

cardiomyopathy is a well described condition that is not often diagnosed, especially in its early

stages when resting cardiac function may appear normal. It is characterized initially by

hyperdynamic circulation, diastolic dysfunction, electrophysiologic changes and later on

systolic dysfunction and possibly outright cardiac failure symptoms. Three unique pulmonary

conditions in portal hypertension include hepatic hydrothorax, hepatopulmonary syndrome and

portopulmonary syndrome. Hepatic hydrothorax is a transudative pleural effusion in the context

of cirrhosis and/or portal hypertension in the absence of significant cardiac, pulmonary and

pleural disease. It is important to recognize hepatic hydrothorax and its complication,

spontaneous bacterial pleuritis ( also called spontaneous bacterial empyema). Management of

this unique effusion is similar to the stepwise management of ascites in portal hypertension and

chest tube drainage is avoided. The two main conditions that may be affected by changes in

pulmonary vasculature are hepatopulmonary syndrome and portopulmonary hypertension. The

diagnosis of either condition impacts survival and may have major clinical implications if liver

transplant is being considered.

Cardiac and Pulmonary Complications of Cirrhosis

Edhel S. Tripon MD

75

Objectives:1. To define the meaning of sarcopenia with particular reference to cirrhotic patients.

2. To discuss the impact of sarcopenia on morbidity and mortality in cirrhosis (including itsimpact on post-transplant outcomes).

3. Introduce the methods that may be used to diagnose and assess sarcopenia in cirrhosis.

4. Evaluate the role of nutrition, dietary supplementation and exercise on the management ofsarcopenia in cirrhosis.

5. Discuss in brief Sarcopenic Obesity in CLD, NAFLD with NASH – how to recognize it andmanagement approaches.

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle

mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life

and, ultimately, death. The most typical symptom of sarcopenia is muscle wasting, defined as a

progressive and generalized loss of muscle muscle mass. For the diagnosis of sarcopenia, the

European Working Group on Sarcopenia in Older People recommends using the presence of both

low muscle mass and reduced muscle function (strength or performance).

The pathogenesis of sarcopenia in cirrhosis has three (3) major contributory causes: inadequate

dietary intake, metabolic disturbance and malabsorption.

Several studies have shown that sarcopenia negatively impacts on the quality of life (QoL), survival

and the development of complications in cirrhosis. It likewise adversely impacts outcomes in

patients on the transplant list, in the peri-transplant period and post-transplantation.

SARCOPENIA IN CIRRHOSIS: Causes, Implications and Management

Jade D. Jamias, MD, FPCP, FPSG, FPSDE

76

Numerous indirect methods have been used to quantify body composition in cirrhotics but most

lack either availability and/or reproducibility and their their accuracy is limited in the presence of

fluid retention. Cross sectional imaging studies, including CT scan or MRI are the gold standard

tools to quantify skeletal muscle mass and hence constitute a good tool for objective nutritional

and metabolic assessment of cirrhotic patients and identification of sarcopenia.

Therapeutic options for sarcopenia in cirrhosis are as follows: 1. increased protein intake, late-

evening snacks, repeated snacks, branched-chain amino acids (BCAAs) and protein

supplementation, 2. Exercise, both aerobic and resistance physical activity, 3. Transjugular

intrahepatic portosystemic shunt (TIPS). Therapies targeting mitochondrial function including

mitochondrial antioxidants, m-TOR signaling and myostatin, hold promise for the future.

The current global obesity epidemic has created a new condition: the combination of sarcopenia

and obesity, described as Sarcopenic Obesity. Obesity is frequently accompanied by NAFLD and it

can progress to NASH and liver cirrhosis. Given the increasing prevalence of NAFLD globally,

sarcopenic obesity will likely to be a major condition in cirrhotic patients in the future.

SARCOPENIA IN CIRRHOSIS: Causes, Implications and Management

Jade D. Jamias, MD, FPCP, FPSG, FPSDE

77

Coagulopathy in Liver Disease - Monitoring, Therapies and

Indications for Blood Products

Teresita Dumagay, MD

Hemostasis among patients with cirrhosis presents its own set of challenges

even amongst the most experienced physicians. While there are guidelines and

recommendations in existence to help manage our patients, it is in individualizing

management strategies in patient care that physicians encounter dilemmas. This

session is intended to provide an avenue to clarify some such dilemmas.

Specifically, this session aims to review the different aspects of coagulopathy in

cirrhosis, discuss often encountered clinical dilemmas in patients with cirrhosis

specifically patients who have abnormal bleeding parameters, discuss rational

monitoring for coagulopathy in cirrhosis peri-procedure, and discuss indications and

thresholds for rational blood product transfusion in cirrhosis.

This session will be case based in format with common clinical cases used as

jump off scenarios in the discussion of each of the objectives.

78

Combined Hepatocellular-Cholangiocarcinoma: Recognition,

Diagnosis and Management

Yi-Hsiang Huang, MD, Ph.D.

Combined Hepatocellular-Cholangiocarcinoma (cHCC-CC) is a rare and distinct subtype of liver

malignancy, accounting for 1% to 14.2% of HCC cases. The features and clinical behavior of

cHCC-CC remain ill-defined. The radiological characteristics of cHCC-CC are varied. On contrast-

enhanced CT a variable pattern of enhancement has been described. Most of the cases have

atypical radiological pattern for HCC in CT scan. Different histologic subtypes of CC have been

shown to have varying enhancement patterns. The diagnosis of cHCC-CC relies on pathological

findings, and it remains a challenging diagnosis prior to resection. According to the 2010 World

Health Organization (WHO) classification, cHCC-CC can be divided into two main categories

based on pathological features: the ‘classical’ type and the ‘stem-cell features’ type. The latter of

which is extremely rare and can be further subclassified into three subtypes: typical,

intermediate and cholangiolocellular carcinoma. Current clinical practice guidelines do not

provide a specific treatment recommendation for cHCC-CC, and surgical resection remains the

only chance of cure, when feasible. The outcome of cHCC-CC is considered to be worse than

HCC alone, however the data were not consistent throughout the reports because of small case

number in different series. In a series of 53 patients with cHCC-CC underwent tumor resection,

the 1-, 3-, and 5-, tumor recurrence rates were 60.8, 71.8, and 80.7, respectively. The 1-, 3-, and 5-

overall survival rates were 73.3, 35.6, and 30.5, respectively. Liver transplantation may not be

considered as a high recurrence rate can be expected. The role of chemotherapy or targeted

therapy with sorafenib for cHCC-CC is still unclear. In conclusion, cHCC-CC is a rare disease

entity, no clear treatment paradigm has yet been defined. Currently, surgery remains the only

effective treatment option.

79

The Emerging Conundrum of Hepatocellular Carcinoma Recurrence

and DAA Therapy for HCV

Jia-Horng Kao MD, PhD, FAASLD

HCV infection is the leading cause of hepatocellular carcinoma (HCC) worldwide. Compared to HCVpatients who fail to achieve sustained virological response (SVR) following interferon (IFN)-based antiviraltherapies, those who achieve SVR have decreased long-term morbidity and mortality. In recent years,treating HCV with IFN-free direct acting antiviral agents (DAAs) has shown superb efficacy and safety andthus becomes the current standard of care for HCV infection. In 2016, Reig et al. reported an alarminglyhigh rate of early HCC recurrence (28%) after DAA therapies among HCV patients who received curativeHCC treatment. Afterwards a serious concern about the benefits of DAA therapy in such patients wasraised. In contrast, subsequent studies from different parts of the world consistently showed that amongpatients with DAA therapy, SVR was associated with a considerable reduction in HCC risk. There was noevidence to suggest that DAAs promote HCC. Nevertheless, in patients with SVR, the absolute risk of HCCremained high in patients with established liver cirrhosis, indicating these patients should receive ongoingHCC surveillance. In a recent meta-analysis on 41 studies, meta-regression adjusting for follow-up periodand age showed that DAA therapy was not associated with higher HCC occurrence (RR 0.68; p=0.55) orrecurrence (RR 0.62, p=0.56). Therefore, there is no evidence for differential HCC occurrence or recurrencerisk following SVR from DAA and IFN-based therapy. In conclusion, the link between HCC occurrence orrecurrence and IFN-free DAA therapy has not been confirmed, more robust data such as randomizedcontrolled trials are urgently awaited to examine this interesting and important issue.

In cooperation with

February 16, 2018 (Friday)8:00 AM to 5:00 PM

SEDA Hotel, Davao City

HSP CPD – 5.75 Units PCP CPD - 2 Units PCOM CME – 5.5 Units PMA CME - 40 Units PAFP CPD– 5 Category II 94

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