A History of the European Society of Coloproctology
2020; Wiley; Volume: 22; Issue: 9 Linguagem: Inglês
10.1111/codi.15307
ISSN1463-1318
AutoresA. J. Shorthouse, R J Nicholls,
Tópico(s)Diverticular Disease and Complications
Resumo……the most valuable legacy of our ancestors, the EACP, the ECCP and all members of the ESCP Executive Committees in the past, should obviously not be forgotten [1]. The European Society of Coloproctology (ESCP) is internationally recognized as the democratic voice of the specialty of coloproctology in Europe and evolved from ideas which first germinated in the 1980s, when the need for a specialist pan-European coloproctological society was first recognized. The ESCP was formed in January 2006 by a merger of the European Council of Coloproctology (ECCP) and the European Association of Coloproctology (EACP). The ambitions of its founder members to create a successful, cohesive and thriving international organization have been realized in a relatively short time, not least due to the dedication, continuity and enthusiastic support of its officers and administration. Financial prudence has been the basis of a solid expanding infrastructure leading to significantly increased value for its membership in terms of education, certification and research [2]. It has taken on many advisory and executive responsibilities in areas including surgical training, continuing professional development (CPD), specialty recognition, accreditation, clinical standards of care and international multidisciplinary research. Its history, already unfamiliar to many of its younger members, needs to be documented before becoming irretrievably lost. The Swiss, French and German national proctology societies met in 1980 to organize an international congress to be held in Strasbourg in 1983 under the chairmanship of Professor Louis Francois Hollender (France) (Fig. 1). This was the forerunner of the ECCP, founded in 1984 as a federation of 11 national societies chaired by Marc-Claude Marti (Switzerland) (Fig. 1). It served an important cohesive function developing contact between Eastern and Western Europe, bringing together those committed to coloproctology as a specialty. Its first meeting was held in Bologna in 1986 with representatives from Austria, Belgium, France, Germany, Italy, Scandinavia, Switzerland and the UK in attendance. There was no individual membership structure. Marc-Claude Marti was responsible for ongoing organizational and financial arrangements. He acted as Treasurer and kept the minutes [3]. The first meeting of the ECCP was held in Bologna in 1986 and the proceedings were reported in an editorial article published in 1987 in the first volume of the International Journal for Colorectal Disease [4] (Table 1). Financial support came from affiliated national societies, paying a levy proportional to each society’s annual income from its membership. The European Council of Coloproctology scientific meetings were biennial and highly successful in bridging Eastern and Western European society aspirations. Its role was predominantly a promoter of education but, as a federation rather than a society with individual membership, it was unable to influence standards or determine accreditation and certification, as in the USA and Australasia. The content of scientific meetings and organization of speakers and chairmen were the responsibility of the local organizer with relatively little central control over scientific quality or finances. This was an ongoing concern for many contemporary colorectal surgeons at the time. Marc-Claude Marti remained Secretary-General until his untimely death in 2001 [5]. He was succeeded by Najib Haboubi (UK) and Jens Kirsch (Germany) (Fig. 1) became Treasurer. Their close links with the EACP subsequently became of pivotal importance during amalgamation negotiations many years later, leading to the formation of the ESCP. From the late 1980s onwards, Roger Grace (UK), John Nicholls (UK) and Philip Schofield (UK) (Fig. 2) explored the idea of a new democratic European colorectal society based on individual membership. They formally approached a prominent group of senior surgeons from Western, Central and Eastern Europe at the ECCP meeting in Barcelona in 1994 which led to an agreement to proceed with the formation of the EACP, finally realizing their ambitions in 1999. It was felt that the different roles of the ECCP and EACP were mutually supportive on the assumption that they would draw closer together with time [6]. Before the millennium, colorectal surgery across Europe was evolving as a subspecialty, especially in the northwestern countries. As late as 2008, and a forerunner to certification, the emergence of colorectal surgery as a discrete subspecialty in Europe was limited to the UK, Ireland and Lithuania, with accreditation for proctology only in Germany. Elsewhere it was part of visceral or general surgery [7]. Conversely, colon and rectal surgery had been recognized as a distinct specialty with accreditation and certification since 1949 in the USA through the foundation of the American Board of Colon and Rectal Surgery in that year [8]. Australasia followed suit in 1992. Today’s complex infrastructure of the ESCP grew from the EACP template. It is therefore important in this context to detail how the EACP evolved. An international working group of senior European surgeons met in Paris in 1997 and again in Rome the following year. Rolland Parc (France), the EACP’s first President (Fig. 3), hosted an inaugural clinical and business meeting at Hôpital St Antoine, Paris, in June 1999. There were 65 Founder Members present, including representatives from Central and Eastern Europe. All agreed to establish the EACP. At the business meeting, chaired by Roger Grace, a constitution was approved and based on those of the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the European Vascular Society. A standing committee prepared for the election of officers at the first Annual General Meeting (AGM) the following year: Rolland Parc (France), Roger Grace (UK and Chairman of the Standing Committee), John Christiansen [Denmark and President of the Division of Coloproctology, Section of Surgery of the Union Européenne des Médicins Spécialistes (UEMS)], Jean-Claude Givel (Switzerland), Hector Ortiz (Spain), Mario Pescatori (Italy), Rudolf Schiessel (Austria), Andrew Shorthouse (UK), Cor Baeten (Netherlands), Thorolf Hagar (Germany), John Nicholls (UK and Secretary of the Division of Coloproctology UEMS) and Lars Påhlman (Sweden). Werner Hohenberger (Germany) and Nick Carr (UK) joined later. There was a commitment to work constructively with the ECCP [5] whilst recognizing the fundamental difference in the aims of the two organizations. Individual membership was the key to cohesion and achieving its aims. Indirect block membership through national associations was excluded. Various membership categories were created to allow the EACP to evolve as a multidisciplinary organization. Fundamental decisions were made to establish membership criteria to facilitate development of political influence, promote the specialty of coloproctology, influence training and clinical standards across Europe and promote international research. An important principle was that administrative costs had to be met by membership dues. It was agreed that in future years the general members of the EACP would nominate Ordinary Members of Council but the Executive alone would recommend senior officers for ratification and election by the membership at the AGM. This served to prevent regional groups electing undemocratically selected candidates into senior positions [9]. The first scientific meeting and AGM were held in September 2000 in Versailles, with Rolland Parc as President and Andrew Shorthouse (UK) as Secretary (Table 2). The meeting focused on Crohn’s disease and included 16 presentations on its various aspects and a further 109 short paper presentations [9, 10]. Andrew Shorthouse made an essential contribution in these initial years in establishing the EACP as a going concern at a time when its success was uncertain. He remained Secretary until 2003 when he handed over to Anders Mellgren (Sweden). The Versailles meeting of 2000 was attended by 178 delegates and took place in a compact and inexpensive venue ideal for the numbers. It was a financial success, with a year-end profit for the Association of €12 300. The scientific meeting was a novel in-depth multidisciplinary symposium on Crohn’s disease [9, 10]. At the first AGM Executive Members and Ordinary Members of Council were elected and included John Christiansen (President), Werner Hohenberger (President Elect), Cor Baeten (President-in-Waiting), Andrew Shorthouse (Secretary), Nick Carr (Treasurer), Anders Mellgren (Assistant Secretary), Mike Parker (Assistant Treasurer) and Freddy Penninckx (Journal Representative). Other elected members of Council were Jean-Claude Givel, Roger Grace, John Nicholls, Hector Ortiz, Lars Påhlman, Rudolf Schiessel, Mario Pescatori and Thorolf Hager (Fig. 4). The venue and Presidents of the further six Annual Meetings of the EACP are shown in Tables 2 and 3, which also include details of the committee structure. Membership categories were defined as Full, Honorary, Trainee, non-European, Corporate, Honorary and Affiliate (e.g. nurses, scientists, technical and allied professions). Voting rights were limited to Full and Honorary Members, the former up to retirement or to the age of 70 years. In 2001, on the suggestion of Bruno Cola (Italy) (Fig. 5) and to ensure fair distribution of the presidency, it was agreed to divide Europe into three geographical parts, Western, Central and Eastern, to allow each country to be represented in a fair and equitable manner. This gave all members a voice, especially those from East European and non-European countries such as Israel. Thus, Presidents rotated over a 3-yearly cycle while the Secretary and Treasurer each served a minimum of 3 years on a staggered basis for continuity of management and administration. These officers were recommended for election by the Executive to Council and ratified by the membership at the AGM. An Assistant Secretary and Treasurer were also appointed to learn the elements of the post, prior to their own election as Secretary and Treasurer. In May 1997 the Section of Surgery of the UEMS approved the formation of the Division of Coloproctology, defining criteria for accreditation and certification in Europe [11] in response to a proposal submitted by John Christiansen and John Nicholls who became its first President and Secretary respectively. They invited the EACP to supply National Representatives to the Division to facilitate international communication with its grass-roots membership. After establishing a constitution, the Division set criteria for accreditation and certification to parallel board certification in the USA. It created the European Board of Surgical Qualification (EBSQ) (Coloproctology) diploma which was first awarded by examination in 1998 in Malmö, Sweden, with Helge Myrvold (Norway), Mario Pescatori (Italy), Manuel Devesa (Spain), Cor Baeten (Netherlands), John Christiansen (Denmark), Marc-Claude Marti (Switzerland), John Nicholls (UK), Thorolf Hager (Germany) and Hector Ortiz (Spain) as examiners (Fig. 6) [11]. An important function of the Division was to identify specialist coloproctology training units across Europe, defined as having at least two surgeons spending 75% or more of their time in colorectal surgery, having university affiliation and trainees with updated logbooks. Units were invited to apply to the Division for training unit recognition [11-13]. Close links with the Division were vital for the EACP to fulfil its aims of raising specialty clinical and training standards across Europe. To this end, the eventual establishment of an Education and Training Committee was important [6, 13]. John Christiansen and John Nicholls were both founding members of the EACP. The former served as President of the EACP in 2001 and the latter was appointed President in 2004 and Programme Chair in 2006. Lars Påhlman (Sweden) became the EACP representative on the Division in 2001 and its own Chair the following year on the retirement of John Christiansen, while Klaus Matzel (Germany) (Fig. 7) took over from John Nicholls. Thus, the officers and National Representatives on the Division of Coloproctology were all closely associated with the EACP and were ideally placed to support the EBSQ examination, training unit assessment and continued professional development. By 2006, there were 89 accredited units [14]. In 1999, the EACP Founder Members adopted Colorectal Disease as its official journal. The Annual Scientific Meeting proceedings were published by the journal from 1999 as its reputation grew to become a leading international multidisciplinary publication. Freddy Penninckx (Belgium) was the Journal Representative on the EACP Council from 2000 to 2003 and was followed by Klaus Matzel. Colorectal Disease was packaged as part of the annual membership subscription. In 2003, John Nicholls, Editor, successfully negotiated the publication of abstracts and peer-reviewed papers by invited speakers in addition to editorial comment at no cost to the EACP. The ECCP had already affiliated with Techniques in Coloproctology. Prior to amalgamation to form the ESCP, both Councils agreed to adopt a journal that would be optional to members but not part of the subscription fee. Despite some ECCP objections to ownership of Colorectal Disease by the ACPGBI, it was formally adopted by the ESCP in 2006. Initially the EACP administration was overseen by Anne O’Mara, the ACPGBI administrator, on an ad hoc basis, but shortly before the first Annual Meeting in 1999 Lindsey Whitehouse (Fig. 8), of the Edinburgh-based company Integrity International Events Ltd (‘Integrity’), was interviewed by Andrew Shorthouse and Nick Carr at the 1999 ACPGBI meeting in Southport and was appointed to manage the EACP membership database, with a view to taking on the eventual organization of conferences and meetings from 2002 onwards. Her role was of crucial importance to the development of the EACP and subsequently the ESCP. Adopting the ACPGBI company model, McClure Naismith (solicitors) and Whitelaw Wells (accountants and auditors) in Edinburgh were appointed to oversee incorporation of the EACP as a Company Limited by Guarantee in March 2000 with recognition by the UK Inland Revenue as a Scottish charity and company. Continuity of centralized administration and consistency of event management from that time were efficient and cost-effective. Financial prudence was necessary from the outset, with secretarial and administration overheads to be met from annual membership fees. A start-up loan of €7700 was granted by the ACPGBI. Major challenges for the EACP, especially in its early days, included balancing the considerable cost of expansion into major conference venues with low numbers of paid-up members paying affordable registration fees. It was necessary to compete with other organizations seeking support from industry, to establish a sufficiently healthy capital base to offset a potentially huge financial loss from a failed congress. Fortunately, there was early generous support offered by the following companies: B Braun Medical, Blackwell Science, Ethicon Endo Surgery, Tyco Healthcare, ML Laboratories, Astra Zeneca and Schering Plough. It was a matter of relief to learn that incorporation as a Company Limited by Guarantee absolved the Executive and membership of any personal liability in the event of a failed meeting and potential insolvency, e.g. from terrorism or natural disaster. A financial commitment to major conference venues at that time was somewhat speculative and risky but essential for expansion. A Board of Trustees (Company Directors) was appointed to ensure that the EACP was compliant with company law and its charitable objectives. Its members included Andrew Shorthouse (UK), Chair from 2000 to 2005, John Christiansen (Denmark), Joe Deasy (Republic of Ireland), Roger Grace (UK), Werner Hohenberger (Germany), Roland Parc (France), John Nicholls (UK), Lars Påhlman (Sweden), Mario Pescatori (Italy), and subsequently Nick Carr (UK) who was Chair after 2005, Leif Hultén (Sweden), Anders Mellgren (Sweden) and Mike Parker (UK) [9]. There were few committees during the early years of the Association (Tables 2 and 3). The Programme Committee, chaired by John Nicholls, was established immediately to organize the Annual Scientific Meeting. A Research and Audit Committee was formed in 2002 under the chairmanship of Lars Påhlman. A website, established in 2000, was expanded under the guidance of Klaus Matzel, to facilitate online applications for membership and conference registration from 2004. National Representatives were appointed to promote coloproctology as a specialty, recruit members locally and organize election of their successors, but most importantly they provided a network of communication between the EACP Council and local grass-roots membership. They were elected on a 3-yearly rolling basis from 2001 onwards to provide continuity of Council membership [15]. The second Annual Scientific Meeting and AGM, held in 2001 at the end of John Christiansen’s presidency, was attended by 220 delegates and hosted by Cor Baeten in Maastricht [16, 17]. The theme was ‘Quality of Life and Function after Rectal Surgery’. Selected abstracts were presented by trainees in each session. A nurses’ symposium was introduced and the EBSQ (Coloproctology) Part II examination was held. Although finances remained tight, the venue was more expensive, but the Dutch government agreed to underwrite 75% of any meeting losses, whilst the EACP retained 90% of the profits and the remaining 10% was allocated for local costs [15]. Despite a small (12%) increase in membership, many Founder Members had failed to join formally, perhaps because in many parts of Europe general surgeons still managed around 80% of colorectal surgery. The third scientific meeting in 2002 was hosted by Werner Hohenberger in Erlangen, with the theme of ‘Trends and Controversies in the Multidisciplinary Management of Rectal Cancer’. It was not a financial success despite its excellent scientific quality. Only just over 200 delegates attended, failing to meet the break-even target of 300. Access to Erlangen was a problem. Speaker expenses of around €40 000 were disproportionately high. An overall loss of €30 000 was partially offset by a value added tax (VAT) refund of €13 170. EACP finances were now precarious, and reserves stood at only €3740. A Welsh Office grant of £22 500 (€35 865 equivalent in 2001) over 3 years, organized by the Treasurer Nick Carr, was crucial to survival. At the 2002 year-end, the combined losses of the Erlangen and Maastricht meetings were €27 692, leaving a capital reserve deficit of €5229. Although membership fees were frozen to encourage recruitment, there were still only 216 members. Despite this the initiation fee of €48 was abolished the following year to encourage new members. It was therefore a very difficult time financially. The EACP was struggling to balance large conference venue costs with income from limited membership fees and conference registrations. It depended heavily on support from industry without which it may not have survived. There was intense competition from other scientific organizations in Europe for a limited pool of funding from industry but, despite this, the EACP received sufficient support which was gratefully acknowledged at the time. A major concern for the Trustees was containment of expenses. This was addressed in a number of ways. Membership fees needed to cover administrative costs. Invited speakers from the USA and elsewhere from outside Europe were limited to a maximum of two business class tickets with hotel accommodation. Non-member European speakers were granted economy travel and hotel accommodation, and EACP members invited to speak or chair sessions were asked to cover their own expenses. It was necessary to increase the membership and an important initiative in this respect, proposed by the representatives of Poland, the Czech Republic and Hungary, was a 2-year trainee-equivalent reduction in membership and conference rates for participants from East and Central Europe, with an option to subscribe to Colorectal Disease at membership-discounted rates. The EACP reached solvency by 2003 with reserves at €38 276, mainly due to an increase in membership, conference rate initiatives and continued support from industry. The positive financial predictions made earlier in the year, however, were heavily dependent on the success or otherwise of the fourth Annual Meeting to be held in Sitges (Spain) in September 2003. In planning the Sitges meeting, targeting and incentives for delegates to become members were required. Corporate membership was mutually beneficial and produced a regular income stream without compromising standards. The potential for bias arising from company-sponsored topics in the scientific programme was avoided by insisting upon evidence-based presentations. The thematic style of the meetings in Versailles, Maastricht and Erlangen had been novel and academically exciting but the in-depth focus of a single topic made no financial sense and was abandoned in favour of a more traditional and pragmatic programme covering multidisciplinary ‘state of the art’ subjects over the entire coloproctology spectrum. This drew a much wider audience, attracted membership and sponsorship, and generated more income. With these tactical changes, the fourth EACP Annual Meeting in Sitges in 2003 attracted over 500 delegates. The more generic theme of ‘Complications in Colorectal Surgery’ was highly successful and far exceeded budget predictions, resulting in a surplus of €67 500. The Mediterranean venue may have been an additional factor for the success of the meeting, not least for delegates from northern Europe, and the addition of CCTV transmission and workshops widened the attraction. Year-end capital reserves exceeded €100 000 for the first time. The ACPGBI loan was fully repaid. The financial position of the EACP by the end of 2003 was by this time secure. By 2003 there was a growing feeling amongst members of both organizations that they should amalgamate into a single society [13, 18, 19]. A concentrated effort was made in the EACP to start negotiations with the ECCP (Fig. 9) for an eventual merger in 2006. The first step in 2004 was a joint meeting of the two organizations in Geneva. A decade earlier, the ACPGBI and the Section of Coloproctology of the Royal Society of Medicine, London, had been invited to host the biennial ECCP congress in Edinburgh in 1997, as part of the ACPGBI’s Annual Scientific Meeting. The ECCP sought input into the programme whilst delegating financial arrangements to the hosts. Unfortunately, the ECCP Council was disenfranchised owing to the release of the final programme before they could endorse it. It was reasonably claimed that the programme was disproportionately biased in favour of the UK. Despite unease, there was a significant Central and East European presence. This further encouraged the idea of forming a new European society despite some souring of relations between the ECCP and ACPGBI, which became a factor behind some difficult ESCP merger discussions over the following decade. Many Central and East European societies were staunch supporters of the ECCP, and antagonistic to the EACP, which might have been regarded as a threat to corporate sponsorship available for ECCP meetings. Poor support for ECCP meetings by some Western surgeons was rightly criticised. Furthermore, the high cost of EACP membership and conference registration for East and West Europeans at a time of economic difficulty after the collapse of the Soviet Union, was a disincentive to join. Many felt that the EACP was biased towards the northwestern part of Europe but, on the other hand, many leaders in the field at that time came from there. In particular, in 1998, the German Coloproctological Society maintained that the EACP would lead to ‘further dissociation of the specialty [of gastrointestinal and hepatic surgery] and … confrontation with the ECCP’ [Personal Communication]. At the 1999 EACP meeting in Paris, Michael Keighley emphasized the importance of amalgamation with the ECCP, which he felt had made an important contribution to the development of European coloproctology, establishing a sense of unity, mainly amongst Central and East European surgeons. However, its predominant role was educational and not specialist training, for which a strong society based on individual membership was necessary to match the specialty recognition and accreditation long established in the USA. The publication of the EACP constitution in 1998 injected a degree of democracy into the ECCP which then revised its own constitution to mirror that of the EACP [18, 19]. However, the ECCP continued to collect membership fees from its affiliated national societies to secure its income stream, but at the same time claimed there was no substantial difference between themselves and the EACP and maintained that EACP expansion would be divisive. It was even suggested that the EACP might become a section of the ECCP. The EACP countered that the ECCP remained undemocratic and therefore was unable to influence the EBSQ (Coloproctology) Part II diploma. Despite these differences, the sides had moved sufficiently closer by 2002 to begin merger negotiations. Their constitutions were by this time fundamentally similar and, increasingly, they shared the same Council members. There was potential benefit if both organizations could work together [6, 19]. The EACP remained committed to the concept of a single European society with equal representation across the regions. A good relationship with the ECCP was therefore an important priority, due to its level of Central and Eastern European support. From the outset the EACP had adopted a pragmatic approach to work closely but in parallel with the ECCP until it had become firmly established and financially secure. Unification was the ideal but, should the ECCP wish to remain independent, then there would need to be coexistence. It was acknowledged that over time one might become dominant with absorption of the other. Their differences were compatible; the ECCP was a confederation of national societies and primarily concerned with education through its biennial meetings whereas the EACP was more politically motivated, aiming for training unit recognition and accreditation. Marc-Claude Marti stressed that conflict was undesirable and brought an EACP representative onto the ECCP Council, proposing that the ECCP Prague meeting in 2001 might be held jointly with the EACP. However, there was insufficient capacity for EACP participation in the main body of the meeting, and EACP members were therefore invited as individuals to participate as speakers or chairmen. Najib Haboubi succeeded Marc-Claude Marti as Secretary-General of the ECCP in 2001 and was a major catalyst for the merger. The EACP and ECCP held parallel Council meetings in Erlangen in 2002, with unanimous agreement that negotiations should formally begin towards amalgamation to create the ESCP. The ECCP stopped planning beyond 2005 on the basis that the newly merged organization would have a meeting in Central Europe. A working group convened in 2003, with equal representation from both Councils and a mandate to explore how collaboration and amalgamation might proceed. The group comprised Cor Baeten (EACP President), Bruno Cola (ECCP), Adam Dziki (EACP) from Poland, Jaroslav Faltyn (ECCP) from the Czech Republic, Najib Haboubi (Secretary General ECCP), Jens Kirsch (Treasurer ECCP), Anders Mellgren (EACP Secretary), John Nicholls (EACP President-elect), Hector Ortiz (EACP), Mike Parker (Treasurer EACP) and Andrew Shorthouse (Chairman and outgoing EACP Secretary). Ioannis Karaitianos (ECCP President) was also an original member of the group which was expanded to include Tomas Skřička (ECCP) from the Czech Republic, Dainius Pavalkis (ECCP) from Lithuania and Yury Shelygin (ECCP) from Russia (Fig. 10). The Working Group met regularly from 2003. Both Councils agreed that negotiations towards a merger should continue. Several Central and Eastern European ECCP members abstained due to a perceived existential threat to the newly established Italian-driven European Club of Coloproctology, launched in Lithuania the previous year. In view of the sensitivities, the Working Group was expanded to include more Eastern and Central European members and recommended that, on its formation, the first President of the ESCP should be from Eastern or Central Europe in support of the new society’s commitment to geographical equivalence. Adam Dziki (Fig. 10) was elected on this basis in addition to his significant contribution to the merger process and his high standing particularly in Eastern and Central Europe. There were considerable difficulties regarding the appointment of administrators, company details, legal representatives, charitable status, and where they should all be based. There were ideological arguments in favour of a Central European base but set against this there were practical and financial reasons for retaining Edinburgh. English was adopted as the official language although provoking the comment from members of Council that ‘there is an evident handicap for Continentals to express themselves perfectly. So no wonder that we all may be “lost in translation” at least from time to time…’ [1]. Anders Mellgren, the EACP Secretary, had an important coordinating role over the merger period, working effectively and seamlessly from Minnesota towards the end of his term. The Merger Group agreed that after amalgamation the ESCP should adopt a journal. The proposal for Colorectal Disease was rejected by the ECCP
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