Gastroenterology and Endoscopic Services Departments, Western Health

• 
  Group Leader
  Associate Professor Alan Moss

  alan.moss@wh.org.au

  +61 3 8345 6666

Research Overview

Within Gastroenterology, we conduct research in the key areas of viral hepatitis (Hepatitis B and C), inflammatory bowel disease (Crohn’s disease and Ulcerative Colitis), chronic liver disease and Clostridium difficile associated diarrhea. We are involved in investigator initiated and industry sponsored clinical trials. Participating in these clinical trials enables our service to provide better patient treatment options and improved patient outcomes for both liver and luminal gastroenterology disease. We are also currently participating in a national audit of inflammatory bowel disease quality of care in collaboration with Crohn’s and Colitis Australia.  We plan to continue to be involved in a range of studies so the unit can continue to improve staff education and teaching, broaden patient treatment options, and improve the outcomes for our patients.

Within Endoscopic Services, our investigator-initiated research has focused on ways to improve our endoscopic clinical outcomes, as well as on quality assurance and audit measures. We are involved in multiple multicenter studies together with other leading endoscopy units in Australasia. The main focus of our research is studying novel endoscopic techniques and monitoring existing and emerging endoscopic techniques that are minimally invasive ways to treat gastrointestinal neoplasia and other pathology, and thereby minimise the need for more invasive surgical interventions that may have greater associated morbidity and mortality. As a result of the outcomes of our studies, we have educated our referring endoscopists about lesion identification, classification and suitability for EMR (endoscopic mucosal resection), avoidance of interventions that impair outcomes, and refined our pathway to EMR via our endoscopy clinic. We also learnt that we have more work to do in the realm of detection of a relatively newly described entity of flat polyps known as sessile serrated adenomas (SSA) and we will focus on educating our endoscopists to enhance detection of these lesions that are likely responsible for some interval colorectal cancers, and then further study our detection rates and outcomes.  We will also aim to further study our success in achieving other quality indicators such as high adenoma detection rates, ERCP efficacy and safety and study the implementation of our new nurse endoscopy program.

Staff

• Associate Professor Alan Moss, Head of Unit, Departments of Gastroenterology and Endoscopic Services
• Dr Ian Kronborg, Gastroenterologist
• Dr Niranjan Arachchi, Gastroenterologist
• Dr Rob Chen, Gastroenterologist
• Dr Steven Kolt, Gastroenterologist
• Dr Shamilah Lachal, Gastroenterologist
• Dr Viet Pham, Gastroenterologist
• Dr Thai Quach, Gastroenterologist
• Dr Daljean Sandhu, Gastroenterologist
• Dr Geeta Srivatsa, Gastroenterologist
• Dr Peter Tagkalidis, Gastroenterologist
• Dr Simon Zanati, Gastroenterologist
• Dr Kumanan Nalankilli, Research Fellow
• Ms Marian Croft, Research Nurse
• Ms Rachel Liddle, Research Nurse
• Ms Kerrie Curin, Research Nurse
• Ms Elizabeth Hristov, Advanced Practice Nurse Endoscopist

Collaborators

• Australia and New Zealand Endoscopy Leaders Forum (ANZELF)
• Australian Colonic EMR (ACE) Study group
• Melbourne Liver Group – HCC (MESH)
• Crohn’s and Colitis Australia

Funding

Some of the hepatitis and inflammatory bowel disease studies attract commercial sponsorship.

Research Publications

1. Nalankilli K, Kannuthurai S, Moss A. A modern approach to ERCP: Maintaining efficacy while optimising safety. Digestive Endoscopy. 2015 Dec 18.
2. Moss A, Nalankilli K. Completing the circle of informed consent for EMR versus surgery for non-malignant large or complex colorectal polyps. Gastrointestinal Endoscopy 2016 May [Epub ahead of print]
3. Moss A, Pham NV. Guidelines for screening and surveillance in inflammatory bowel disease: Just a "rough guideline" or a cornerstone of high-quality modern medical practice? Gastrointest Endosc. 2015 Oct;82(4):715-7.
4. Moss A, Williams SJ, Hourigan LF, Brown G, Tam W, Singh R, Zanati S, Burgess NG, Sonson R, Byth K, Bourke MJ.
   Long-term adenoma recurrence following wide-field endoscopic mucosal resection (WF-EMR) for advanced colonic mucosal neoplasia is infrequent: results and risk factors in 1000 cases from the Australian Colonic EMR (ACE) study. Gut. 2015 Jan;64(1):57-65.
5. Pellise M, Burgess NG, Tutticci N, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, P'Ng H, Mahajan H, McLeod D,  BourkeMJ.
   Endoscopic mucosal resection for large serrated lesions in comparison with adenomas: a prospective multicentre study of 2000 lesions.
   Gut. 2016 Jan 19
6. Jayanna M, Burgess NG, Singh R, Hourigan LF, Brown GJ, Zanati SA, Moss A, Lim J, Sonson R, Williams SJ, Bourke MJ.
   Cost Analysis of Endoscopic Mucosal Resection vs Surgery for Large Laterally Spreading Colorectal Lesions.
   Clinical Gastroenterology and Hepatology. 2016 Feb;14(2):271-278
7. Ahlenstiel G, Hourigan LF, Brown G, Zanati S, Williams SJ, Singh R, Moss A, Sonson R, Bourke MJ; Australian Colonic Endoscopic Mucosal Resection (ACE) Study Group. Actual endoscopic versus predicted surgical mortality for treatment of advanced mucosal neoplasia of the colon. Gastrointestinal Endoscopy. 2014 Oct;80(4):668-76.
8. Burgess NG, Pellise M, Nanda KS, Hourigan LF, Zanati SA, Brown GJ, Singh R, Williams SJ, Raftopoulos SC, Ormonde D, Moss A, Byth K, P'Ng H, McLeod D, Bourke MJ.
   Clinical and endoscopic predictors of cytological dysplasia or cancer in a prospective multicentre study of large sessile serrated adenomas/polyps.  
   Gut. 2016 Mar; 65(3):437-46.
9. Moss A. From gastroenterologist to surgeon to gastroenterologist for management of large sessile colonic polyps: something new under the sun?
   Gastrointestinal Endoscopy. 2014 Jan;79(1):108-10.
10. Moss A. Colonic Tattooing: The revival of a “black art”? Gastrointestinal Endoscopy 2012 Oct;76(4):801-3
11. David Whiteman, Mark Appleyard, Farzan Bahin,..., Alan Moss et al. Australian Clinical Practice Guidelines for the diagnosis and management of Barrett’s oesophagus and early oesophageal adenocarcinoma. J Gastroenterol Hepatol. 2015 May;30(5):804-20.
12. Kazankov K, Rode A, Simonsen K, Villadsen GE, Nicoll A, Møller HJ, Lim L, Angus P, Kronborg I, Arachchi N, Gorelik A, Liew D, Vilstrup H, Frystyk J, Grønbæk H. Macrophage activation marker soluble CD163 may predict disease progression in hepatocellular carcinoma. Scand J Clin Lab Invest. 2016 Feb;76(1):64-73.
13. Lee A, Rode A, Nicoll A, Maczurek AE, Lim L, Lim S, Angus P, Kronborg I, Arachchi N, Gorelik A, Liew D, Warner FJ, McCaughan GW, McLennan SV, Shackel NA. Circulating CD147 predicts mortality in advanced hepatocellular carcinoma. J Gastroenterol Hepatol. 2016 Feb;31(2):459-66.
14. Wright, E. K., P. De Cruz, M. A. Kamm, A. L. Hamilton, K. J. Ritchie, S. Krejany, A. Gorelik, D. Liew, L. Prideaux, I. C. Lawrance, J. M. Andrews, P. A. Bampton, S. Jakobovits, T. H. Florin, P. R. Gibson, H. Debinski, A. S. Day, R. B. Gearry, F. A. Macrae, D. Samuel, R. W. Leong, I. Kronborg, G. L. Radford-Smith, W. Selby, M. J. Johnson, R. Woods, P. R. Elliott, S. Bell, S. J. Brown, W. Connell and P. V. Desmond "Su1318 Intestinal Resection in Crohn's Disease Is Associated With Significant and Durable Improvement in Health Related Quality of Life Although to a Lesser Extent in Women and Smokers. Results From the POCER Study." Gastroenterology (2014).   146(5, Supplement 1): S-435.
15. Wright, E. K., P. De Cruz, M. A. Kamm, A. L. Hamilton, K. J. Ritchie, S. Krejany, S. T. Leach, J. I. Keenan, A. Gorelik, D. Liew, L. Prideaux, I. C. Lawrance, J. M. Andrews, P. A. Bampton, M. Sparrow, T. H. Florin, P. R. Gibson, H. Debinski, F. A. Macrae, R. W. Leong, I. Kronborg, G. L. Radford-Smith, W. Selby, M. J. Johnson, R. Woods, P. R. Elliott, S. Bell, S. J. Brown, W. Connell, A. S. Day, R. B. Gearry and P. V. Desmond "998 Faecal Calprotectin Is Superior to Faecal Lactoferrin and S100A12 As a Surrogate Marker for Post-Operative Crohn's Disease Endoscopic Recurrence. Prospective Longitudinal Endoscopic Validation. Results From the POCER Study." Gastroenterology (2014).  146(5, Supplement 1): S-174.
16. Wright, E. K., M. A. Kamm, P. De Cruz, A. L. Hamilton, K. J. Ritchie, E. O. Krejany, S. Leach, A. Gorelik, D. Liew, L. Prideaux, I. C. Lawrance, J. M. Andrews, P. A. Bampton, S. L. Jakobovits, T. H. Florin, P. R. Gibson, H. Debinski, F. A. Macrae, D. Samuel, I. Kronborg, G. Radford-Smith, W. Selby, M. J. Johnston, R. Woods, P. R. Elliott, S. J. Bell, S. J. Brown, W. R. Connell, A. S. Day, P. V. Desmond and R. B. Gearry "Measurement of Fecal Calprotectin Improves Monitoring and Detection of Recurrence of Crohn's Disease After Surgery." Gastroenterology (2014) In Press, Uncorrected Proof.
17. Kamm, M. A., P. P. De Cruz, E. K. Wright, A. L. Hamilton, K. J. Ritchie, E. O. Krejany, A. Gorelik, D. Liew, L. Prideaux, I. C. Lawrance, J. M. Andrews, P. A. Bampton, S. L. Jakobovits, T. H. Florin, P. R. Gibson, H. S. Debinski, A. S. Day, R. B. Gearry, F. A. Macrae, D. Samuel, R. W. Leong, I. J. Kronborg, G. L. Radford-Smith, W. S. Selby, M. J. Johnson, R. J. Woods, P. R. Elliott, S. J. Bell, S. J. Brown, W. R. Connell and P. V. Desmond "OP023 Optimising post-operative Crohn's disease management: Best drug therapy alone versus endoscopic monitoring, disease evolution, and faecal calprotectin monitoring. The POCER study." Journal of Crohn's and Colitis (2014).   8: S13.
    De Cruz, P., M. A. Kamm, A. L. Hamilton, K. J. Ritchie, E. O. Krejany, A. Gorelik, D. Liew, L. Prideaux, I. C. Lawrance, J. M. Andrews, P. A. Bampton, P. R. Gibson, M. Sparrow, R. W. Leong, T. H. Florin, R. B. Gearry, G. Radford-Smith, F. A. Macrae, H. Debinski, W. Selby, I. Kronborg, M. J. Johnston, R. Woods, P. R. Elliott, S. J. Bell, S. J. Brown, W. R. Connell and P. V. Desmond "Crohn's disease management after intestinal resection: a randomised trial." The Lancet. (2014). In Press, Corrected Proof P 1-11.