Sections

MUSC GI/Hepatology Course - 2014

Nisha Patel

I am very grateful to the BSG for allowing me to visit the Digestive Disease Centre at the Medical University of South Carolina (MUSC) for the Advanced Endoscopy / Hepatology course. I was one of 10 gastroenterologists lucky enough to be a guest of the legendary Professor Peter Cotton and his team at their state-of-the-art Digestive Disease Centre (DDC). The programme was tailored to our specific interests, but enabled us to see a wide range of gastroenterology services and therapeutic procedures.

The DDC located inside the Ashley River Tower afforded amazing views of the river and Charleston itself in many wards, patient rooms and waiting areas (a definite change to the dreary NHS mustard coloured walls). The dynamic multi-disciplinary gastroenterology team that welcomed us work cohesively in a friendly patient-orientated environment with a strong drive towards the optimisation of patient centred care through research and teaching. The bubbly Phyllis, the departmental nurse lead, gave us a tour of the wards and endoscopy unit allowing us to appreciate the layout of the unit as well as the management and administrative aspects to running a successful working unit. The individual patient rooms with river views and TV/computers with the ability to order lunch or dinner was in stark contrast to their British counterparts. The modular ward layout and nursing with a 4:1 ratio is something the NHS could only dream about.

The endoscopy unit itself had multiple individualised purpose-built rooms for ERCP and EUS. Peter had designed the unit from inception and seen it through to completion. This meant the layout made sense and was patient and user friendly. Endoscopy lists were well organised, not overbooked and split into lists with conscious sedation and those with general anaesthetic. The general anaesthetic lists were conducted in a separate area to the conscious sedation lists, with as expected fewer procedures per list but the same nurses and administrative staff looking after them which the patients loved! The unit also had in-room histopathology services with live links to a Histopathology Attending at another site. This meant an immediate in-room result was achievable during EUS and FNA of a lesion.

The patient pathway from admission to the unit to discharge was smooth and was a great example of effective and efficient service delivery, something which British units could learn from.

The update in gastroenterology and hepatology comprised a number of extremely well presented talks focussing around clinically problematic areas such as biliary dyskinesia and biliary strictures and finished with informative breakout sessions in IBD, advanced endoscopy and liver disease.

In between the 2 days, we enjoyed the company of Peter and his team at a wonderful restaurant in a converted cotton mill with delicious seafood in a lively environment: the perfect end to a fabulous trip! The experience allowed me to see the differences between the US and UK systems and to take back some ideas for service and managerial improvements to my own department in a bid to improve our delivery of care. A final thank you must go to Simon and others at Olympus, the BSG for choosing me, and Tracy Farber for making sure I got there to experience this fabulous opportunity!

 

MUSC GI/Hepatology Course 2014

Venkat Mahesh

It is such a fantastic opportunity to report on my experience at the 'Medical University of South Carolina', (abbreviated as MUSC). I was overjoyed to be one of the 10 members of BSG to visit MUSC digestive diseases centre. After much preparation (mostly swapping on call commitments), I managed to arrive a day before the scheduled visit to MUSC. Charleston is a fantastic place, indeed where the history lives, as claimed by its official website. The beautifully preserved architecture, plentiful gardens and historic homes and WWII carrier, all very impressive indeed.

More impressive were the welcoming people at MUSC. It was such a warm welcome by Cynthia Peeples and the ever energetic Phyllis (nurse lead for MUSC). For all his greatness, the legend himself was very friendly and humble. Peter Cotton not only gave a brief peek into his career but also how he came to develop the very well planned Digestive Diseases Centre in the Ashley River tower at MUSC. We also felt very special when he presented his excellent book 'The tunnel at the end of light' - an endoscopic journey in 6 decades. All the more happy to see it was autographed by the author!.

A superb tour with all the interesting anecdotes by Phyllis made us really appreciate the Digestive Diseases Centre's ethos much better. It was fantastic to observe some of the best endoscopists performing the 'usual chores' and not even a bit nervous about the international crowd intently watching them!

A mini-CME by Dr Arun Sanyal into the pathogenesis of NASH and a full CME the next day with varied topics was truly informative and also entertaining. But the main entertainment, I felt, was on Friday night in a well chosen restaurant, relaxed and friendly chat with Peter Cotton, one of the gurus of motility- Don Castell, Mrs Cotton, Mrs Cook, Phyllis, and visiting team- we enjoyed great food and friendly banter, not to mention the selfies!

It was such a well thought out mix of experience and interests by the BSG, all of us felt the time at MUSC was very rewarding indeed. I would like to thank Tracy Farber (for organising accommodation and a lot more), Cynthia Peeples (fellowship co-ordinator), ever so friendly and patient staff at DDC, Drs Hoffman, Cote, Elmunzer, Castell, Elias, Lodhia, all the fellows and of course Prof Cotton.

I would like to thank again BSG and Olympus for supporting this educational endeavour. Most of all, I also need to acknowledge my wife's support for managing on her own with a 5 month old and a 6 year old!

BSG/WAGE Travelling Endoscopy Fellowship - Tokyo 2014

Many thanks to the BSG and to WAGE for the opportunity to spend 2 weeks at the National Cancer Centre Hospital in Tokyo.

A brand new endoscopy unit had recently opened, and we were struck by the amount of equipment and endoscopes there were and the sheer vastness of the unit – 12 rooms over 2 floors. Although it seemed slightly overwhelming at first, the team were incredibly welcoming and kind so that by the end of the first day we were comfortable moving between rooms to observe the different procedures and to ask any questions.

BSG/SSG Advanced Endoscopy Fellowship – National Cancer Centre, Tokyo 2012: Dr Perminder Phull

The 2 week fellowship at the National Cancer Centre in Tokyo was an outstanding opportunity to observe advanced cancer endoscopy at one of the world's premier institutions.

The details of the Endoscopy Division set-up, staffing, timetable and types of cases have been well documented in the reports by Dr Bateman, Dr Mead and Dr Smart. There was much to learn and prompt review of one's own practice in the UK. From a training perspective, the practice of trainees acting as assistants in therapeutic procedures has much to commend it. It was very interesting to observe endoscopist-administered propofol sedation for all non-high-risk cases. One very important lesson to take away was the meticulous attention paid to detail during the endoscopic procedure, and also the routine use of NBI and chromoendoscopy. It was fascinating to see how few biopsies are taken for histology, with the emphasis very much being on endoscopic confirmation of malignancy and also staging for the majority of early cancers.

BSG Travelling Endoscopy Fellowship – Annual Endoscopy Update 2013, Florida Hospitals, Orlando

Dr Sandeep Siddhi

21st - 23rd May 2013

At the outset I must thank the BSG and Olympus Keymed for organising and sponsoring this travelling fellowship programme. This Endoscopy course, over the years has grown to be one of the most prestigious and reputed courses in the world with the faculty consisting of ‘endoscopy superstars’ from all over.

The timing of this update could not have been better as it gave me an opportunity to attend DDW as well. It was also the first time the course was organised in Orlando and had a new format compared to the previous editions. Dr. Hawes who has taken up the mantle from Dr. Peter Cotton has pursed this with the same vision and enthusiasm. The theme of “Endoscopy Beach meeting” continues as it was organised in the Disney Beach and Yacht Club.

Report on Fellowship to Attend 18th Annual Advanced Endoscopy Update, Florida USA - Dr Mayur Kumar

21st - 23rd May 2013

I was extremely privileged to be selected for the 2013 BSG travelling fellowship to the 18 annual advanced endoscopy update in Orlando. Traditionally this fellowship had been hosted by Dr. Peter Cotton and his team at MUSC- South Carolina, but this year the meeting was hosted by the brand new interventional endoscopy unit at Florida Hospital, Orlando- lead by Dr. Rob Hawes. The timing of the fellowship was excellent as it was scheduled immediately after DDW offering us the opportunity to attend two world class meetings consecutively.

Our fellowship started with a visit to the ultra modern interventional endoscopy unit housed at Florida hospital where Dr. Rob Hawes and his team gave us a tour of state-of-the-art endoscopy suite. The unit was equipped with all modern advanced endoscopy equipment in large rooms with huge monitor screens, modern fluoroscopy equipment and intraprocedure facilities for histopathology. This was an extremely useful tour as it highlighted the need for modern technology to perform advanced endoscopy. The faculty and staff were extremely friendly.

Report on Fellowship to Attend 18th Annual Advanced Endoscopy Update, Florida USA

Dr Sebastian Zeki

21st - 23rd May 2013

Gastroenterologists are a pretty sociable bunch and so it was that the 10 of us who had successfully applied to the BSG travelling fellowship managed to find each other having never met before, outside the immensity of the Orlando Convention Centre at DDW 2013. The first part of the tour involved a trip to the interventional endoscopy unit at Florida Hospital. This was an impressive and extremely new unit offering all the latest in innovative advanced endoscopy together with a magnificent waiting room overlooking a pond. I was particularly impressed by our host's (Dr Robert Hawes) explanation of how innovation, rather than just an optimistic watchword, was being actively encouraged by the unit's interaction with industry and the presence of on site 'wet labs' allowing new endoscopic techniques to be experimented with. They also had an on site 3D printer to allow rapid redesign of experimental endoscopic apparatus thus speeding up the innovation.

Opportunities such as the BSG travelling fellowship are a unique way to find out not only how cutting edge endoscopy is done across the world but also to compare our own practices with US practice. With this in mind the Advanced Endoscopy Update conference started in earnest within the convention centre of our hotel. The impressive live link allowed us to see the doyens of international endoscopy (Hawes/ Tarnasky/ Bourke/ Yamamoto/ Costamagna/Deviere/ Eubanks and Maydeo amongst others) take up the mantle of what were very challenging cases and of course made them look straightforward. The cases were varied and gave a perspective of what can be achieved in endoscopic practice.

The location of the conference also added a new dimension to endoscopy being the Disney Yacht Club so the first evening was spent with 10 gastroenterologists staring at the Disney fireworks on the Boardwalk with one happy delegate who had been to Disneyland with his children more times than was normal, giving us a virtual guided tour of what the park has to offer.

The final day offered us several more interesting cases and a chance to listen to Peter Cotton discuss training and safety in ERCP- probably one of the most important lessons of the conference. Despite the seriousness of the message, the magical kingdom had clearly also had an effect as he ended his talk with a cautionary message from a hand puppet who I think was Fred the Snake from his latest children's book- a man of diverse talents.

The conference was excellent and to watch the grand masters of endoscopy was a very special pleasure. It's just a shame I can't apply to go next year.

Report on Fellowship at National Cancer Centre, Tokyo

Dr Paulose George

November 2012

Background:

I was granted a fellowship in May 2012 by the BSG and WAGE to visit the National Cancer Centre in Tokyo. As the lead Gastroenterologist for the Cross Border Upper GI Cancer Centre based at Wrexham and accredited screening colonoscopist I have been doing endoscopic resection of early GI cancers since 2008. Endoscopic resections of early cancers offer a cure without the morbidity and mortality that is often associated with major surgery. Endoscopic treatment of GI cancers was pioneered by the Japanese and is now gaining popularity world wide. This technique started as endoscopic mucosal resection (EMR) but gradually evolved into endoscopic submucosal dissection (ESD) allowing en bloc resection of large lesions and histological confirmation of a curative resection. The advanced diagnostic endoscopy practised in Japan improves detection of early cancers of GI tract and prediction of depth of invasion of these early lesions based on pit pattern and capillary vascular pattern.

Fellowship:

Institution – Endoscopy Division, National Cancer Centre Hospital, Tokyo

Period – 19 Nov – 30 Nov 2012

Mentor - Dr. Takahisa Matsuda

I spent the normal working hours Monday to Friday in the busy endoscopy unit with 7 rooms undertaking on an average 20 colonoscopies and 50 upper GI endoscopies per day. Their routine work included advanced diagnostic techniques to detect early cancers and a range of therapeutic work such as complex EMR, ESD and EUS guided FNA, offering good case mix and excellent learning environment.

MUSC Advanced Endoscopy Fellowship 2012: Dr Shyam Menon

The advanced endoscopy fellowship has been a fantastic opportunity to visit the well-known MUSC endoscopy unit and I am grateful to BSG for supporting it. The fellowship has required a lot of planning and organisation and I thank everyone involved in making it successful. I am very grateful to Dr. Peter Cotton for hosting us and overseeing the fellowship.

The MUSC GI unit is located in a state-of-the-art building by the picturesque Ashley River with a panoramic view of Charleston harbour. The endoscopy unit is large and spacious, with purpose-built ERCP and EUS facilities. Although our programme was tailored to our specific interests, we watched a diverse range of therapeutic endoscopic procedures during our stay. A striking difference in endoscopic practice for me, was the use of anaesthesia for therapeutic endoscopy.

MUSC Advanced Endoscopy Fellowship 2011: Prof. Jonathan Brown

Medical school: The Ashley river tower accommodates the gastroenterology and cardiology divisions of the Medical University of South Carolina. This is an imposing building that is only 4 years old. The GI offices are on the 7th floor with views over the town and river. The endoscopy rooms are on the 2nd floor.

Academic content: This comprised exposure to the business and administration departments of the GI section of the medical school, almost daily ERCP and EUS opportunities, lecture theatre based departmental teaching, research in progress and case presentations, ward rounds, motility, histopathology and radiology meetings.

Page 1 of 2