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.

There was the chance to observe gastric and colonic ESD on a daily basis as well as screening endoscopies – all performed meticulously and with multiple standardised images taken. Just watching the endoscopists undertaking these procedures have provided us with insights into the 'tips and tricks' that can be applied in our every day practice. For example; working in retroflexion, closing defects using a combination of clips and an endoloop, and there was a very nifty use of a clip attached to a length of cotton to lift up the mucosa during ESD to improve access for the last part of submucosal dissection. We also witnessed double balloon colonoscopy to access the caecum in order to undertake ESD where a standard colonoscope did not provide a stable enough position for endotherapy. There were also interesting variances to our practice in the UK, for example the fact that the residents rather than nurses assist each procedure, the use of endoscopist-administered propofol as sedation, and the availability of multiple endoscopes for each procedure!

We were welcome to attend the various meetings, which were held in English, which reviewed endoscopy findings, planned therapy and reviewed cases with histology following endoscopic treatment. The collaborative nature of the endoscopy unit is something that is clearly desirable and we should aspire to apply this further in the UK, despite the other demands during the working day.

Above all the 2 weeks were a fantastic networking opportunity and a chance to meet and share experiences with other fellows from Australia, Taiwan, Italy, Argentina and France. Tokyo itself is a vibrant and beautiful city, with amazing food, and one of the highlights of the trip was a meal out with the endoscopy team where we had to cook our own Monjya (a type of Japanese pan-fried batter with various ingredients).

All of the endoscopists were very humble, despite their ability and it was a pleasure to spend time with them and get to know them (and they were more than happy to exchange contact details to stay in touch!). Special thanks to Drs Saito, Matsuda, Abe and Yamada. Dr Saito in addition to his endoscopic expertise was also able to accurately predict the day when the cherry blossoms would bloom!

Dr Joanna Hurley (Wales) and Dr Michael Mitchell (Northern Ireland)