December 2012 ACG 7
ACG Grant Recipient Travels to Japan for Intensive Training
in Endo...
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Published on: Mar 3, 2016

Transcripts - NA_Intl_Training_Grant_2012_Update_Article

  • 1. December 2012 ACG 7 C O L L E G E N E W S ACG Grant Recipient Travels to Japan for Intensive Training in Endoscopic Submucosal Dissection T he North American International GI Training Grant allowed me to go the National Cancer Center Hospital in Tokyo, Japan to learn about endoscopic submucosal dissection. To address the high incidence of gastric cancer within Japan, they have developed unique en- doscopic skills to detect and resect early gastric cancer (EGC). Endoscopic sub- mucosal dissection (ESD) is an advanced endoscopic technique used to resect early gastric cancer with exceptional outcomes. Adoption of this technique in the West has been poor due to the rarity of early gastric cancer detection and its steep learn- ing curve. This has made it difficult to learn this technique within the U.S. With extension of the indications of ESD to the esophagus and colon, there has been a growing interest in ESD in the West. I was honored to have the opportunity to learn about ESD under the mentorship of Dr. Yutako Saito, the Chief of Gastro- enterology at the National Cancer Center (NCC) in Tokyo, Japan. The NCC endos- copy division is focused on the detection, characterization, and management of early gastrointestinal cancer. This allowed the perfect location to observe the Japanese process of managing early gastrointestinal cancer from detection to resection. Morning endoscopy was primarily fo- cused on detection and characterization of lesions. As early cancerous lesions in the gastrointestinal tract may be subtle altera- tions in the mucosa, screening exams are careful systematic examinations of the en- tire mucosa extending from the pharynx to the duodenum. The process of being able to detect and macroscopically estimate the depth of invasion of lesions is a complex skill set in itself. What I learned in morn- ing endoscopy was enforced by multi- specialty confer- ences that reviewed the mac- roscopic appearance of lesions and their pathologic findings. Afternoon endoscopy included ESD procedures being performed in the phar- ynx, esophagus, stomach and colon. This allowed me to understand the indications, logistics and technique of performing ESD in each location. There were between 3-7 ESD procedures performed daily at the NCC. This large exposure to ESD allowed me to truly understand the details and nu- ances of the ESD procedure. Under the guidance of the staff of the NCC, I was able to perform ESD in an ex vivo pig model, and start my training in ESD. ESD has a steep learning curve with the potential for significant complications, and it is best to overcome this initial phase in a porcine model. I also learned the por- cine training model used at the NCC. My interest is in the detection and man- agement of early gastrointestinal cancer. My trip to the NCC allowed me to under- stand the indications, logistics and tech- nique of performing ESD. Since returning to the United States, I have been able to implement a porcine training model at my own institution to continue my training in ESD and share my experiences. Dr. Saito and the staff at the NCC were the most gra- cious hosts and I am grateful to the ACG for the opportunity to learn from them. In this issue of the ACG Update, we are highlighting the 2011 ACG North American International GI Training Grant recipient, Amit Bhatt, MD, of the Cleveland Clinic in Cleveland, Ohio. This grant provides partial financial support to U.S. and Canadian GI fellows-in-training or GI physicians who have completed their train- ing within the last five years, to receive clinical or clinical research training in Gastroenterology and Hepatology outside of North America. As the winner of the 2011 grant, Dr. Bhatt traveled to Tokyo, Japan to train in endoscopic submucosal dissection. ACG is proud to have been able to play a positive role in his career development. ACG Dr. Amit Bhatt (left) with his Tokyo mentor Dr. Yutako Saito. (left) The group from the National Cancer Center Hospital in Tokyo, Japan, where an ACG North American International GI Training Grant allowed Dr. Bhatt to receive training in endoscopic submucosal dissection, some of which was conducted using porcine models (above). By Amit Bhatt, MD

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