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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.

My main aim for going to the NCC was to observe advanced EMR and also ESD, for which there were daily opportunities. We were also given the opportunity of practicing ESD on a porcine model (much to the amusement of the trainees supervising us!)

Naturally, the experts (including the chief residents) made the procedures look easy, but it has to be appreciated that training in cancer endoscopy takes 5 years in Japan. ESD is a highly complex procedure; cases with extensive or multiple lesions can often take many hours to complete.

The visit to Tokyo also provided an opportunity to sample Japanese food and culture. It was interesting to observe that cultural differences also appeared to affect endoscopic practice: there was no nurse/assistant present at the patient's head during gastroscopy and not once did we observe a patient gagging or requiring suction!

I am very grateful to the BSG and the SSG for providing this superb opportunity to enhance my endoscopy knowledge and skills. I would like to thank Dr Matsuda, Dr Saito, Dr Oda and their staff for providing such an enjoyable fellowship experience and also for their generous hospitality.