9th Congress of the
European Council of Coloproctology
May 31-June 4, 2003
The Coloproctology in the 3rd Millenium
A major part of gastroenterology and of general
surgery involves the diagnosis and treatment of colorectal and anal
diseases. In the era of absolute specialization, the majority of
patients with diseases of the lower part of the gastrointestinal track,
are still treated by general physicians or general surgeons.
But today, coloproctology has become a speciality,
like urology or orthopedic surgery or cardiovascular surgery in certain
Using the words of John Alexander Williams, "the
speciality of coloproctology has grown from the art of ‘anology’, a
study of conditions limited to that distance from the anal verge that
could be inspected easily by torch or candlelight or with the aid of a
single speculum. Two centuries ago, many proctological ills were often
treated by itinerant quacks, partly because the physician considered
himself rather too grand to meddle around the anus and the medical
profession in general tended to look down on those who studied anal
Gastroenterologists had a more special education in
the field of the colorectal diseases. Almost half of their four to five
years of training is dedicated in the diagnosis and the treatment of the
diseases of colon, rectum and anus. The support of this subspeciality of
internal medicine is essential for the management of patients with
diseases of the lower gastrointestinal tract.
The continuous technical evolution of the endoscopic
diagnostic tools, such as video endoscopy, chromoendoscopy, zoom
endoscopy, endoscopic ultrasound, capsula endoscopy, etc, now offer new
possibilities for a more accurate diagnosis for a large spectrum of
On the other hand, the minimal invasive endoscopic
techniques like lasers and colorectal stenting, can resolve palliatively
several problems of advanced colorectal cancer without the need of
surgical intervention with a lower morbidity and mortality rate and
shorter hospitalization time than surgery. Also, the large majority of
colorectal polyps, are removed, nowadays, by endoscopy, with excellent
Virtual colonoscopy, is a relatively new and very
promising diagnostic method for the detection of colorectal malignancies
and precancerous lesions. Based on the computer technology, this
painless technique has the possibility to become a routine diagnostic
tool for the detection of colorectal malignancies in the future.
The progress in the instrumental methods used in the
treatment of hemorrhoidal disease of the Ist, IInd
and even IIIrd degree, is very important
and these methods, are curatives in 80% - 90% of cases when operated by
the experienced surgeons and in their proper indications.
But also, the new surgical techniques for
hemorrhoids, like stapler hemorrhoidectomy and doppler guided selective
hemorrhoidal arteries ligation, became very popular in the last few
years and replaced the classic Milligan - Morgan hemorrhoidectomy in the
majority of cases.
The treatment of anal incontinence with dynamic
graciloplasty and sacral nerve stimulation, is very promising also over
the last few years.
The total mesorectal excision, represents a
revolution in the management of rectal cancer and so, the necessity of
postoperative radiotherapy is now uncertain and a subject of
international clinical trials.
However, colorectal surgeons, must be educated
meticulously in these methods of treatment, to ensure the best results.
On the other hand, the evolution of the adjuvant and
neoadjuvant chemotherapy in colorectal cancer with the use of new, very
efficius and safe antineoplastic agents, has ameliorated significantly
the survival rate of the cancer patients.
Two major questions have aroused with the entry of
the new millenium, about the present and mainly the future of
coloproctology in Europe.
In our new, big country (Europe), is there a place
for some doctors dedicated to the treatment of colorectal diseases? Is
coloproctology a speciality or subspeciality in Europe in it’s own right?
I think the answer is positive for both questions.
In the United States, coloproctology has been
recognized as a speciality for many years.
In Europe, is still a part of general surgery.
Together and in strong collaboration with the
abdominal surgeons, a great number of gastroenterologists, radiologists,
oncologists, pathologists and nurses, is involved in the diagnosis and
treatment of colorectal disorders and today, in almost every big
European hospital, there are working teams with main scientific interest
the diseases of the lower gastrointestinal tract. In the fields of large
bowel cancer, inflammatory bowel diseases, functional disorders and anal
diseases, many of the advances have come from European units. But,
unfortunately, in the domain of medical and surgical education, European
coloproctology still remains a misty landscape.
The necessity for a common European educational
program in coloproctology, is now greater than ever and not for the
surgeons only. Gastroenterologists, internists and even pathologists,
radiologists and nurses, must receive a special education in the field
of coloproctology after the basic in their speciality training. This
is not a personal opinion. It is a need of our times. This is not for us,
it is for the benefit of our patients.
In the vast majority of the European countries, with
an exception of the United Kingdom and Ireland, there is no specific
educational program in colorectal surgery, during or after the surgical
training, despite the fact that in recent years there have been
published many papers, which have proved that the surgeon is an
independent and very important prognostic factor for the outcome of
patients operated for colorectal diseases and especially for colorectal
The division of Coloproctology of the European
Section of UEMS (Union Europeene des Medecine Specialistes) had proposed
the guidelines for the educational promotion of coloproctologic surgery
in Europe. An examination to coloproctology, leading to the diploma EBSQ
(European Board of Surgery Qualification) Coloproctology, takes place
during each annual meeting of the European Association of Coloproctology
In conclusion, Coloproctology is a new speciality
with excessive development nowadays. But, Coloproctology is no more a
one man show!! There is an increase need for the creation of a working
team of scientists, including all doctors and nurses involved in the
diagnosis and treatment of colorectal disease in each hospital.
I truly believe in the very important role of
European Societies of Coloproctology, especially the ECCP and the EACP
working together for the success of this effort.
Professor Ioannis G. Karaitianos
President of the ECCP