9th Congress of the
European Council of Coloproctology
Athens, 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 countries.

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 disease".

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 colorectal diseases.

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 results.

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 adenocarcinoma.

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 (EACP).

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



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