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• W2737816928 abstract "At the 93rd Congress of the Japan Gastroenterological Endoscopy Society in Osaka, held on 11–13 May 2017, three international symposiums were held. Here we report on two of these symposiums concerning gastrointestinal endoscopy. In this session, each speaker presented papers about training situations from various countries including USA, Sweden, Philippines, Latin America, Vietnam, Cambodia, Hong Kong, and Japan, each followed by a short discussion on the topic (Fig. 1). This session allowed Japanese and foreign experts to exchange opinions and improve mutual understanding (Table 1). A theme in many presentations was teaching the use of endoscopic diagnosis and treatment to overcome gastrointestinal cancer at early or precancerous stages. Japanese endoscopists have played an important role in this objective, which has been especially facilitated by the availability in Japan of a well-resourced social health system, many endoscopically detectable and treatable early-stage lesions, and the wide expertise of seasoned endoscopists who are willing to guide junior doctors, compared with foreign countries.1 Because few foreign countries have Japan's teaching resources in this area, some foreign doctors visit Japan to learn advanced endoscopic diagnostic and therapeutic techniques such as image-enhanced endoscopy or endoscopic submucosal dissection (ESD), and bring the techniques back to their own countries. Their results have been comparable to those of Japanese clinicians.2 Aihara H (Brigham and Women's Hospital, Boston, MA) showed that ESD procedures in the USA increased from ~200 in 2012 to ~1500 in 2017. However, over half of colon surgeries in the USA yield pathologically benign tumors, which account for over 300 000 cases. In the Philippines, many patients with large polyps are also sent to surgery because endoscopic resections (such as wide-piecemeal endoscopic mucosal resection [EMR] or ESD) are not yet commonly recognized as safe procedures. Clearly, these techniques should therefore be more widely validated, taught and used. Presenters also discussed the establishment and experiences of endoscopy training centers in Boston, Kobe and Nagoya. Many Japanese endoscopists attend ESD training courses in foreign countries, whereas many foreign endoscopists visit Japanese training centers, and thus exchange knowledge and techniques. Overseas working experiences of Japanese clinicians in the USA, Sweden, Philippines, Vietnam and Cambodia were presented. Interactions between Japanese and local endoscopists further promote distribution of advanced endoscopic techniques.3 The effectiveness of e-learning systems for teaching diagnosis of early gastric cancer was presented.4, 5 In many countries, gastric cancer is too often diagnosed at an advanced stage. Yao K. et al. enrolled 332 endoscopists from 35 countries in a randomized controlled trial, and showed that an Internet-based e-learning system significantly improved test scores for endoscopic detection of early gastric cancer. Image-enhanced endoscopy (IEE) can improve recognition and characterization of early gastrointestinal cancers. Chiu PWY et al. introduced the activities of the Asian Novel Bio-Imaging and Intervention Group (ANBIG), which was established to conduct standardized training in endoscopic diagnosis and treatment of early gastrointestinal cancers in Asia. From November 2013 to November 2016, 41 workshops were conducted in Asia at 40 facilities, with 1863 delegates, of whom 660 completed the pre-test and the post-test. When test results were prospectively collected and later compared, participants showed significant improvement after training in all tested domains, including basic knowledge of IEE, and diagnosis of early esophageal, gastric and colorectal neoplasia. Continuous research is needed to improve diagnosis and treatment through digestive endoscopy. Suzuki H suggested that cultivating a research mind among endoscopists in training was extremely important for progress of endoscopic medical care. In this session, six presenters talked about their specialized fields. Japanese experts and foreign counterparts presented alternately with short discussions (Table 2). First, Sekiguchi M talked about “Current status and future perspectives regarding colorectal cancer screening in Japan”. Incidence and mortality rates of colorectal cancer (CRC) in Japan are persistently high despite the introduction of the CRC screening system, which indicates the need to further distribute CRC screening in Japan. Major problems of screening include low participation rates for the current population-based screening program using a fecal immunochemical test (FIT) and for follow-up colonoscopies after positive FIT results; insufficient evaluation of the effectiveness of CRC screening modalities; unestablished quality-control system; insufficient evaluation in terms of cost-effectiveness and examination capacity; and lack of a nationwide screening database. With regard to the cost-effectiveness of CRC screening in Japan, model analysis using Japanese data has recently been conducted and indicates that more frequent use of screening colonoscopies might improve both effectiveness and cost-effectiveness of CRC screening in Japan.6 However, as limited nationwide capacity for colonoscopies could impede their widespread use, an optimal CRC screening schedule should be further discussed considering the nationwide colonoscopy capacity. In this context, the Japan Endoscopy Database Project was recently initiated by the Japan Gastroenterological Endoscopy Society, and aims to collect nationwide endoscopy data in Japan, and to clarify relevant trends in this field, including the nationwide colonoscopy capacity. Second, East J. from the UK discussed inflammatory bowel disease and neoplasia. Persistent inflammation leads to an elevated risk of CRC in patients with extensive colitis. Recent international consensus guidelines (Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations [SCENIC]) now recommend surveillance with chromoendoscopy. Detected dysplasias should ideally be removed en bloc to optimize histological evaluation of specimens and reduce the risk of local recurrence. However, submucosal fibrosis and submucosal fat deposition make en-bloc resection challenging, even with ESD techniques. Third, Oka S. explained about JNET classification. Several narrow-band imaging (NBI) magnifying endoscopy classifications for the diagnosis of colorectal tumors (Sano, Hiroshima, Showa, and Jikei classifications) have been used in Japan. The new unified classification proposed by the Japan NBI Expert Team (JNET) has four categories based on vessel and surface patterns. Types 1, 2A and 3 are reliable indicators of hyperplastic polyps or sessile serrated adenoma/polyps, adenomas, and deep submucosal invasive cancers, respectively,7 and should be followed up, resected endoscopically, and sent to surgery, respectively. Type 2B lesions are higher-grade neoplasia with histologically varied lesions, from high-grade adenoma to deep submucosal invasive cancer. Pit-pattern diagnoses with magnifying crystal violet chromoendoscopy are currently necessary for accurate diagnosis of type 2B lesions to determine treatment strategy. Fourth, Hassan C. discussed “Surveillance after polypectomy or colorectal cancer surgery”. After high-quality colonoscopy, the European Society of Gastrointestinal Endoscopy Guidelines recommend 3-year surveillance for the high-risk group (patients with adenomas with villous histology, high-grade dysplasia or adenomas ≥10 mm in size, or ≥3 adenomas), but with screening after 10 years for the low-risk group (patients with 1–2 tubular adenomas <10 mm with low-grade dysplasia).8 For patients who have undergone CRC surgery, a recent meta-analysis has shown that most of the risk is concentrated in the first 48 months, which supports intensive surveillance during this period. Fifth, Hayashi Y. discussed treatment options for colon polyps, cold-snare polypectomy, the resect and discard strategy, EMR, ESD, and laparoscopy endoscopy-assisted colorectomy. He also mentioned that ESD, which has been difficult to introduce in Western countries,1 became easier with the use of the pocket-creation method (PCM).9 Western endoscopists are already familiar with peroral endoscopic myotomy, which is a similar technique to PCM. Finally, Veitch A. talked about colonoscopy in patients on anticoagulants or antiplatelets, which is increasingly common in an aging society. Purely diagnostic colonoscopy is safe in all patients taking antithrombotics. Guidelines from Japan, UK, Europe and USA allow mucosal biopsy in patients taking antiplatelets or warfarin. British/European guidelines recommend withholding one dose of direct oral anticoagulant (DOAC) before biopsy, but American guidelines allow biopsy on DOAC. Aspirin can be continued for standard colonoscopic polypectomy, but withdrawal should be considered for large EMR or ESD. Recent guidelines provide algorithms for the management of DOAC in the context of endoscopy, but are based on limited evidence.10 Authors thank all the presenters and participants, and Hiroyasu Iishi, the President of the Congress. Authors declare no conflicts of interest for this article." @default.
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• W2737816928 title "Report of the international symposiums at the 93rd Congress of Japan Gastroenterological Endoscopy Society in Osaka, 2017" @default.
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