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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.

MUSC Advanced Endoscopy Fellowship 2011: Dr Adam Haycock

I am very grateful to the BSG for allowing me this chance to visit the Digestive Disease Centre at the Medical University of South Carolina (MUSC). I was one of four gastroenterologists who spent 8 days in this unit as a guest of Dr Peter Cotton and his team.

I am very grateful to the BSG for allowing me this chance to visit the Digestive Disease Centre at the Medical University of South Carolina (MUSC). I was one of four gastroenterologists who spent 8 days in this unit as a guest of Dr Peter Cotton and his team.

MUSC Advanced Endoscopy Fellowship 2011: Dr Michael Chapman

Thank you to the BSG, Peter Cotton and support from Boston Scientific for the opportunity to visit the excellent Digestive Disease Centre at the Medical University of South Carolina (MUSC) in Charleston, USA.

Peter Cotton and the team had arranged a full programme for the 10 day visit allowing us to get a taste of US health care (academic, private and Veterans Affair systems), advanced endoscopy (mostly ERCP), EUS and GI training schemes. Every day, arrangements had been made for us to visit new people and departments, all of whom were incredibly welcoming, open and helpful. The unit at MUSC is a new purpose built unit with 9 endoscopy rooms with full time dedicated ERCP and EUS rooms, exactly the type of unit we all aspire to have back home in the UK. The team were very generous with their hospitality allowing us to enjoy some informal evenings with good company and southern cuisine. Also, we quite enjoyed being driven around by Peter Cotton in his golf buggies whilst visiting his local private island residence!

MUSC Advanced Endoscopy Fellowship 2011: Dr Yiannis Kallis

The BSG travelling fellowship provided me with an invaluable experience to learn about advances in endoscopy from an array of expert speakers from around the world. There are several aspects of the MUSC course that stand out as particular highlights listed below. Some have allowed me to reflect on and improve my own endoscopic practice, whereas others have more generally afforded me a broader perspective on my practice.

It was a privilege to have seen Peter Cotton’s final ERCP demonstration and to have been involved in the last MUSC course before his retirement. It was inspiring that he had been able to attract such an eminent line-up of speakers, who had all been at one stage taught by him, and who clearly felt a debt of gratitude. What came across was the sense of legacy, more familiar to an American-educated rather than European-educated doctor,. This was manifest in Dr Cotton’s efforts to fundraise to maintain the MUSC advanced endoscopy fellowship, and certainly resonates with what I have experienced in the last few years in the UK where universities and medical schools are seeking more benefaction from their alumni.

MUSC Advanced Endoscopy Update 2011: Dr Tom Lee

It was an honour to have the opportunity to attend the annual Advanced Endoscopy Update in South Carolina in May 2011. This followed straight on from the DDW in Chicago. On our arrival, we were given a tour of the Digestive Diseases Centre at the Medical University of South Carolina in Charleston. Peter Cotton introduced us to the Centre then a resident showed us around the wards and the 7 room endoscopy unit.  The general feel of the Centre was more like a hotel than a hospital with flat screen televisions and internet connections in every room.

MUSC Advanced Endoscopy Update 2011: Dr Ishfaq Ahmed

After attending chaotic DDW sessions in the windy city of Chicago, I arrived in the sunny city of Charleston, South Carolina. Dr. Peter Cotton, the founder and former Director of the Medical University of South Carolina’s Digestive Disease Centre, kindly arranged lunch for all delegates from the UK. After lunch he showed us the historic town of Charleston and we arrived at the impressive Digestive Disease Centre (DDC) of MUSC.

MUSC Advanced Endoscopy Update 2011: Dr Khaleel Jamil

This year's Advanced Endoscopy Update in Charleston was a momentous one indeed. For this was the swan song for the grandfather (and grandmaster) of ERCP, Peter Cotton. Those of us lucky enough to attend received the usual excellent updates and expert opinion, but this year's meeting had a poignant atmosphere, and it felt as though we were witnessing a small part of history. This was crystallised in a session where we watched a live feed of Dr Cotton performing his last ever ERCP, after which Ian Taylor remarked "This may sound like hyperbole, but that felt like watching the first man walk on the Moon". Hyperbole, perhaps, but it was mesmeric seeing the expert in action -  he completed the procedure in 13 minutes, leaving the moderators the awkward task of improvising a Q and A for the majority of the hour set aside for the demonstration!

MUSC Advanced Endoscopy Update 2011: Dr Safa Al-Shamma

The Course

The venue for the course was spacious and comfortable with bountiful refreshments available. The faculty was a who’s who of international stars in endoscopy. All were experts in the field at the top of their game. All lectures were state of the art with excellent updates on the relevant topics. Of the most impressive was Prof Nagi from Hyderabbad. He gave an authoritative update on ERCP and demonstrated some outstanding work done in the poorest rural areas in India. The majority of the work was free and depended on donations.

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