​Dr Jeanne Lubbe from the Department of Surgery at Stellenbosch University (SU) has been awarded a joint doctoral degree from SU and Karolinska University in Sweden.

Lubbe (44) is currently head of the divisions of upper gastrointestinal surgery and metabolic surgery at SU's Faculty of Medicine and Health Sciences.

In February this year she successfully defended her PhD dissertation, “Aspects on Advanced Procedures during Endoscopic Retrograde Cholangiopancreatography (ERCP) for Complex Hepatobiliary Disorders", in Huddinge, Sweden.

Her road to completing her combined PhD started in 2013 with her first visit to Huddinge for a three-month endoscopy fellowship at Karolinksa University Hospital.

“Amongst many lessons learnt during my first stay, what stood out was the fact that clinical questions should be answered not from personal experience, but from real life data, exemplified for endoscopy by GallRiks, the Swedish registry for cholecystectomy and endoscopic retrograde cholangiopancreatoscopy (ERCP). The fellowship allowed me to not only be exposed to state-of-the-art endoscopic practice, but also made me aware of the research possibilities if health care data is collected and applied responsibly," she says.

Soon after this visit a bilateral agreement was signed between Karolinska University and SU for setting up a dual PhD programme, and Lubbe's double PhD degree came to be in June of 2016.

Her thesis's main research questions centre around advanced procedures that are performed during ERCP for complex hepatobiliary disorders. It has two main interventions as focus points - firstly, the performance of cholangioscopy (SpyGlass), a relatively new technology, and secondly, endoscopic stenting in the hepatic hilum.

According to the agreement between the two universities, the requirements for a PhD at both universities had to be met individually. As both allowed a PhD based on publications, Lubbe's thesis encompassed four publications.

The first two publications scrutinised the performance of cholangioscopy in the population of patients attending a single, large endoscopy centre (Huddinge), but then also in the nationwide population of patients that underwent cholangioscopy between 2007 and 2014 in Sweden. An important finding was that cholangioscopy added significant clinical value in 63% of patients in whom it was used. Most value lies in the treatment of gallstones, but a second important function is in the diagnosis whether strictures are cancerous.

The two later studies investigated hilar endoscopic stenting in the Swedish population but also in all patients undergoing palliative hilar stenting in the Western Cape. When compared to stents placed in distal bile duct, hilar stenting was associated with an increased risk of adverse events.

When comparing hilar stenting via an endoscopic route with hilar stenting via a percutaneous route (the traditional way), both access routes performed similarly, with endoscopically placed stents remaining open for longer, probably because more stents could be placed at the time of the procedure. Results suggested, however, that the two routes each have advantages as well as disadvantages, and in future can be used complimentary rather than competitively.

“This 'double' PhD has been a blessing in so many ways," says Lubbe. “Besides for allowing me to spend a year in total in the most special of all the Nordic Countries, I was privileged to be exposed to PhD procedures, required courses, ethics regulations, and the culture surrounding what it means to become a 'doctor' at two independent universities."