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From iraqi kurdistan to japan


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Japan training course in GIT endoscopy.

Japan training course in GIT endoscopy.

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  • 1. From Iraqi Kurdistan to Japan: science & picnic. 1-19/3/2011. Dr. Mohamed Shekhani Dr. Hiwa Abubakir Husein. Kurdistan center for gastroenterology & hepatology, As-Sulaimaniyah –Iraqi Kurdistan.
  • 2. Arriving at Nagoya: the Suchi welcome party
  • 3. The popular Japanese suchi dish : Raw fish
  • 4. Nagoya city center
  • 5. Nagoya city center
  • 6. Nagoya city center
  • 7. Nagoya city center
  • 8. Nagoya city center
  • 9. Given a chance to present in Kumamoto RC Hospital.
  • 10. Welcome party in Kumomoto city.
  • 11. Kumomoto city & castle.
  • 12. Kumomoto: Japanese gardens Aso mountain& the green tea Ice cream.
  • 13. Given chance to deliver talks in Aichi cancer center-Nagoya.
  • 14. Aichi cancer center: Nagoya
  • 15. Aichi cancer center endoscopy unit: with Dr. yamao kenji
  • 16. Endoscopy practice in Japan:
    • Updated.
    • Confident.
    • Hard working:
    • 9 AM- 9 PM.
    • Never leave before completing his case even if it is the time to leave or rest.
    • Example: ESD for early CRC: 5 hours on his feet.
    • High standard patient care:
    • Not allowing any foreign doctor to touch the patient.
    • Patient data are patient privacy & should not be given to any one without his consent.
    • Friendly & cooperative.
    • Excellent team working:
    • GIE U/L Team.
    • Hepatobiliary (ERCP-EUS Team).
  • 17. Upper GIT endoscopy :
    • Patient has his code.
    • Patient presents with all the previous data in a big file.
    • Previous operations well illustrated graphically.
    • Previous endoscopic findings recorded & pictured.
    • Every patient appointed in advance, who will do the endoscopy.
    • Endoscopist will map the mucosa during entry & withdrawal.
    • Patients come to the endoscopy unit by appointment, 1-2 patients only at the same time.
    • Qualified nurse will welcome the patient in the waiting room, explain, take consent, give him/her antifoamimg agent to drink(semithscone + bicarbonate), xylocaine jell to keep in the mouth & throat for a period ( by an alarm watch given to the patient) then swallow or spit.
    • Patient enters to the endoscopy room, his belongings put in a specified container.
  • 18. Upper GIT endoscopy :
    • Endoscopist uses semithscone/bicarbonate to wash the mucosa through syringing to see have better view.
    • Esophagus: use NBI, ME, Iodine chromoendoscopy for diagnosis of early esophageal cancer & decide whether there is or no submucosal invasion to decide on doing ESD/EMR or send the patient for surgery or Chemoradiotherapy.
    • Suck excess iodine pooled in the stomach (irritant) & neutrilize by thiosulphate once the procedure is complete.
    • Map the antrum & incisura.
    • Go to the duodenum D1/D2.
    • Return to the antrum to do complete retroflexion to see the fundus by rotating the scope 360 degrees.
    • Suck any pooling fluids in the fundus totally.
    • Use IEE by NBI,ME,Indigocarmine to characterize any suspected lesion & avoid unnecessary biopsies.
    • The aim is an accurate endoscopic diagnosis.
  • 19. Upper GIT endoscopy :
    • At least 40 endoscopic pictures are saved in the computer & 4 printed.
    • Time spent: around 40 mins for normal OGD & 40 mins for abnormal ones.
  • 20. Endoscopy practice in Japan:
    • Frontiers in endoscopy research contributing to both English & Japanese literature.
    • Many Japanese GIT & GIE journals.
    • One English GIE journal ( digestive endoscopy).
    • Head of dept of GE: Yamao Kinji: 150 English article/300 Japanese.
    • Japanese endoscopic atlases& books.
  • 21. Endoscopy practice in Japan:
    • Pioneers in chromoendoscopy, NBI, magnifying endoscopy, ERCP & EUS.
    • Leaders in early diagnosis of GIT & pancreatobiliary cancers by screening asymptomatic persons for upper GIT Cancers in addition to usual colorectal cancer screening.
    • Open access endoscopy.
    • Even < 45 years old.
    • On request even if younger or asymptomatic( by Barium or by endoscopy if requested by the person).
    • High risk persons: smokers , alcoholic or HN cancers.
  • 22. Endoscopy practice in Japan:
    • Leaders in the endoscopic mucosal resection(ESD) of early GIT cancers.
    • Excellent 5 year survival of most GIT cancers.
  • 23. Intra-papillary capillary loops (IPCL) AVM: arborescent vascular network, PA: perforating artery, PV: perforating vein
  • 24. IPCL pattern
  • 25. Non-magnifying NBI image White-light image Lugol chromoendoscopy NBI image
  • 26. Magnifying NBI image Mucosal esophageal squamous cell carcinoma
  • 27. Magnifying NBI image Submucosal esophageal squamous cell carcinoma
  • 28. Stomach ME : Microvascular& Surface microstructure pattern
  • 29. Case1 Case2
  • 30. Which is a malignant lesion? Focal gastritis Gastric cancer
  • 31. Magnifying Endoscopy
  • 32. CRC ME: Pit pattern
  • 33. Ⅰ Ⅱ Ⅲ S Ⅲ L Ⅳ Ⅴ N Ⅴ I Normal round crypts, regular Enlarged stellar crypts, regular Narrowed round pits, irregular Branched or gyrus-like crests Irregular surface Amorphous surface Elongated, sinuous crests Pit pattern ( Kudo & Turuta’s classification )
  • 34. Ⅰ Ⅱ Ⅲ S Ⅲ L Ⅳ Ⅴ N Ⅴ I normal pattern Hyperplastic polyp Serrated adenoma irregular pattern non-structure pattern regular pattern Pit pattern and treatment selection No treatment Endoscopic resection Surgery Endoscopic resection or Surgery Nonneoplastic Neoplastic, adenomatous Neoplastic, cancer
  • 35. (インジゴカルミン散布) 0-IIa slightly elevated
  • 36. Chromoscopy ( Indigo carmine ) ( Magnify )
  • 37. Visiting Hiroshima: The Dome will remind us of the Destructive effects of WMD.
  • 38. Nagoya city streets& markets
  • 39. Nagoya city& castle Bullet train
  • 40. Nagoya city streets& markets
  • 41. Nagoya city streets& markets
  • 42. Nagoya city streets& markets
  • 43. Tempura farewell party& Healthy Japanese dishes.
  • 44. Great thanks to:
    • Aichi cancer center gastroenterology & endoscopy unit.
    • Kumomoto red cross hospital.
    • For their great help & support during our stay & training in their hospitals & cities.
    • Special thanks to Dr. yamao kenji, head of department of gastroenterology in Aichi cancer center.