What we learn from Japan on advanced endoscopy: strength and weakness

The role of the japanese school in digestive endoscopy has been major and continue to be so. It reflects some of the main characteristics of the japanese expert character (as seen by a modest western colleague) : innovation, precision, skill, deduction. The more impressive personality trait is the deductive reasoning of a japanese expert during lesion characterization : the diagnosis is suggested following a systematic analysis of image details. Whereas a western expert usually gives an hypothesis at once on a general impression. Same during detection : Western endoscopists usually search for abnormalities of relief whereas a japanese endoscopist also look for abnormalities of color. Japanese endoscopists have thus to continue to teach the world on the importance : to work with high quality imaging, to analyse all details, to closely collaborate with the pathologists, to be precise and methodical during diagnosis and treatment. Another main message we should learn from the japanese school is the intellectual curiosity for new technologies and new techniques. It is more difficult to find weaknesses : quality of methodology during clinical research, which was discussed some years ago, has improved. The major weakness does probably concern more the way to transmit the messages to the western endoscopists who are more interested by procedure duration, costs, ….These are nevertheless important points which have to be taken into account.