What we learn from Japan…and what could be done further to foster greater international understanding and collaboration

Advanced mucosal imaging and resection techniques have markedly altered how lesions are tackled in the gastro intestinal tract (GIT). Japan has pioneered numerous groundbreaking technologies that have enabled Endoscopists worldwide to detect, characterize and treat dysplastic and early GIT cancer. Amongst these Chromoendoscopy, Narrow Band Imaging and Magnification endoscopy appeared to have gained widespread use. Minimally invasive approaches such as Endoscopic Mucosal Resection (EMR), Endoscopic Submucosal Dissection (ESD), Per Oral Endoscopic Myotomy (POEM) and Submucosal Tunneling Endoscopic Resection (STER) have resulted in less morbid outcomes for significant number of patients.

From an endoscopic imaging viewpoint, standardization of various classification systems is paramount. There is an urgent need for less rigorous and easy to understand terminology that can be widely disseminated, practiced and reproduced with consistency especially in the community. ‘On site’ mentoring by experts who perform complex resections could be a useful way to further disseminate the knowledge and technical skill required to perform these procedures. It may also be possible to have specific educational symposia in the English medium to promote greater understanding. Allowing trainees from overseas to train in Japanese institutions could also enhance international collaboration.