Japan GIT endoscopy training course.March 2011.


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From iraqi kurdistan to japan

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Japan GIT endoscopy training course.March 2011.

  1. 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. 2. Suchi welcome party
  3. 3. The popular Japanese suchi dish : Raw fish
  4. 4. Nagoya city center
  5. 5. Nagoya city center
  6. 6. Nagoya city center
  7. 7. Nagoya city center
  8. 8. Nagoya city center
  9. 9. Given a chance to present in Kumamoto RC Hospital.
  10. 10. Welcome party in Kumomoto city.
  11. 11. Kumomoto city & castle.
  12. 12. Kumomoto: Japanese gardens Aso mountain& the green tea Ice cream.
  13. 13. Given chance to deliver talks in Aichi cancer center-Nagoya.
  14. 14. Aichi cancer center: Nagoya
  15. 15. Aichi cancer center endoscopy unit: with Dr. yamao kenji
  16. 16. Endoscopy practice in Japan: <ul><li>Updated. </li></ul><ul><li>Confident. </li></ul><ul><li>Hard working: </li></ul><ul><li>9 AM- 9 PM. </li></ul><ul><li>Never leave before completing his case even if it is the time to leave or rest. </li></ul><ul><li>Example: ESD for early CRC: 5 hours on his feet. </li></ul><ul><li>High standard patient care: </li></ul><ul><li>Not allowing any foreign doctor to touch the patient. </li></ul><ul><li>Patient data are patient privacy & should not be given to any one without his consent. </li></ul><ul><li>Friendly & cooperative. </li></ul><ul><li>Excellent team working: </li></ul><ul><li>GIE U/L Team. </li></ul><ul><li>Hepatobiliary (ERCP-EUS Team). </li></ul>
  17. 17. Upper GIT endoscopy : <ul><li>Patient has his code. </li></ul><ul><li>Patient presents with all the previous data in a big file. </li></ul><ul><li>Previous operations well illustrated graphically. </li></ul><ul><li>Previous endoscopic findings recorded & pictured. </li></ul><ul><li>Every patient appointed in advance, who will do the endoscopy. </li></ul><ul><li>Endoscopist will map the mucosa during entry & withdrawal. </li></ul><ul><li>Patients come to the endoscopy unit by appointment, 1-2 patients only at the same time. </li></ul><ul><li>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. </li></ul><ul><li>Patient enters to the endoscopy room, his belongings put in a specified container. </li></ul>
  18. 18. Upper GIT endoscopy : <ul><li>Endoscopist uses semithscone/bicarbonate to wash the mucosa through syringing to see have better view. </li></ul><ul><li>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. </li></ul><ul><li>Suck excess iodine pooled in the stomach (irritant) & neutrilize by thiosulphate once the procedure is complete. </li></ul><ul><li>Map the antrum & incisura. </li></ul><ul><li>Go to the duodenum D1/D2. </li></ul><ul><li>Return to the antrum to do complete retroflexion to see the fundus by rotating the scope 360 degrees. </li></ul><ul><li>Suck any pooling fluids in the fundus totally. </li></ul><ul><li>Use IEE by NBI,ME,Indigocarmine to characterize any suspected lesion & avoid unnecessary biopsies. </li></ul><ul><li>The aim is an accurate endoscopic diagnosis. </li></ul>
  19. 19. Upper GIT endoscopy : <ul><li>At least 40 endoscopic pictures are saved in the computer & 4 printed. </li></ul><ul><li>Time spent: around 40 mins for normal OGD & 40 mins for abnormal ones. </li></ul>
  20. 20. Endoscopy practice in Japan: <ul><li>Frontiers in endoscopy research contributing to both English & Japanese literature. </li></ul><ul><li>Many Japanese GIT & GIE journals. </li></ul><ul><li>One English GIE journal ( digestive endoscopy). </li></ul><ul><li>Head of dept of GE: Yamao Kinji: 150 English article/300 Japanese. </li></ul><ul><li>Japanese endoscopic atlases& books. </li></ul>
  21. 21. Endoscopy practice in Japan: <ul><li>Pioneers in chromoendoscopy, NBI, magnifying endoscopy, ERCP & EUS. </li></ul><ul><li>Leaders in early diagnosis of GIT & pancreatobiliary cancers by screening asymptomatic persons for upper GIT Cancers in addition to usual colorectal cancer screening. </li></ul><ul><li>Open access endoscopy. </li></ul><ul><li>Even < 45 years old. </li></ul><ul><li>On request even if younger or asymptomatic( by Barium or by endoscopy if requested by the person). </li></ul><ul><li>High risk persons: smokers , alcoholic or HN cancers. </li></ul>
  22. 22. Endoscopy practice in Japan: <ul><li>Leaders in the endoscopic mucosal resection(ESD) of early GIT cancers. </li></ul><ul><li>Excellent 5 year survival of most GIT cancers. </li></ul>
  23. 23. Intra-papillary capillary loops (IPCL) AVM: arborescent vascular network, PA: perforating artery, PV: perforating vein
  24. 24. IPCL pattern
  25. 25. Non-magnifying NBI image White-light image Lugol chromoendoscopy NBI image
  26. 26. Magnifying NBI image Mucosal esophageal squamous cell carcinoma
  27. 27. Magnifying NBI image Submucosal esophageal squamous cell carcinoma
  28. 28. Stomach ME : Microvascular& Surface microstructure pattern
  29. 29. Case1 Case2
  30. 30. Which is a malignant lesion? Focal gastritis Gastric cancer
  31. 31. Magnifying Endoscopy
  32. 32. CRC ME: Pit pattern
  33. 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. 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. 35. (インジゴカルミン散布) 0-IIa slightly elevated
  36. 36. Chromoscopy ( Indigo carmine ) ( Magnify )
  37. 37. Visiting Hiroshima: The Dome will remind us of the Destructive effects of WMD.
  38. 38. Nagoya city streets& markets
  39. 39. Nagoya city& castle Bullet train
  40. 40. Nagoya city streets& markets
  41. 41. Nagoya city streets& markets
  42. 42. Nagoya city streets& markets
  43. 43. Tempura farewell party& Healthy Japanese dishes.
  44. 44. Great thanks to: <ul><li>Aichi cancer center gastroenterology & endoscopy unit. </li></ul><ul><li>Kumomoto red cross hospital. </li></ul><ul><li>For their great help & support during our stay & training in their hospitals & cities. </li></ul><ul><li>Special thanks to Dr. yamao kenji, head of department of gastroenterology in Aichi cancer center. </li></ul>