BSG/MGS Advanced Endoscopy Fellowship - NCCH, Tokyo 2011: Dr JM Bateman

The National Cancer Centre Hospital deals with cancer patients or those with pre-cancerous conditions eg FAP. Patients are referred with a diagnosis already established. They are assessed and treated. Post treatment surveillance is usually undertaken by NCCH.

The Endoscopy Department undertakes 'cancer' endoscopy (upper GI endoscopy, colonoscopy and bronchoscopy, no ERCP), endoscopy training and research. Out patient clinics allow patients to be informed of treatment options, with detailed information being provided and consent obtained. Patients have a high expectation of being offered endoscopic treatment for early cancers and pre-malignant lesions with either endomucosal resection (EMR) or endoscopic submucosal resection (ESD). Following endoscopic submucosal resection a 5 day in patient stay is standard. The endoscopist who has performed the procedure remains responsible for that patient and for the treatment of any complications that may arise. A typical day will have morning surveillance/assessment UGI endoscopy and EUS lists. The afternoons are given over to surveillance/assessment colonoscopy and therapeutic colonoscopy and upper GI endoscopy.

The team is based on a strict hierarchy of senior/staff endoscopists, senior residents and residents. Training in cancer endoscopy takes 5 years, 2 as a senior resident). They perform surveillance endoscopy and learn colonoscopy under supervision. The aim is to develop a gentle (80% of colonoscopy is performed without sedation) and meticulous technique: routine examination, includes the mouth and pharynx) is with white light, chromendoscopy (indigo carmine/chrystal violet/Lugol’s iodine) and narrow band imaging. To develope therapeutic skills trainees observe procedures and assist the endoscopist by passing instruments, injecting, clipping and snaring, tasks normally performed by endoscopy nurses in the UK. This allows familiarisation with the large numbers of different instruments used, appreciation of the techniques employed as well as developing accurate lesion recognition. Animal model training in polypectomy by EMR and ESD is undertaken. Trainees progress through EMR to ESD on patients, >20 ESDs for gastric antral lesions are performed before the first rectal ESD is performed. As skills improve the trainee will progress to procedures in the colon, oesophagus and upper stomach.

These standards of examination and training should be our aim while appreciating the differences in culture, disease pattern and resources in Japan compared with the UK.

Thanks to Dr Takahisa Matsuda and all in the Endoscopy Department at NCCH as well as the Endoscopy Section of the BSG and the Midlands Gastroenterological Society for supporting this Fellowship.

JM Bateman
Consultant Gastroenterologist
Shrewsbury and Telford Hospital NHS Trust