| Recent collaborations between gastroenterologists and industry in the United States have allowed the development of new technologies that have the potential to improve procedural safety, duration and clinical outcomes of complex therapeutic endoscopic procedures. In the United States, each advanced endoscopist is required to have the ability to perform multiple advanced procedures including endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreatography (ERCP), stenting, balloon enteroscopy in addition to bariatric endoscopy and third-space endoscopy. Due to the different medical insurance system in the United States, most of these advanced procedures are required to be performed as outpatient procedures or with only 1 or 2 nights of observation hospital stays. Regarding the training system in advanced endoscopy, currently, advanced endoscopy fellowship programs are offered by approximately 100 institutions in the United States; however, most of these programs are 1-year program and the fellows are required to start their clinical practice as independent attending physicians immediately after the completion of the program. These aspects of the socio-economic situation in the United States different from Japan have resulted in the above-mentioned development of technologies to facilitate these complex procedures and potentially shorten the learning curve for the advanced endoscopy fellows. In this lecture, I would like to discuss the differences between the training programs in Japan and the United States and introduce technologies recently developed for advanced endoscopic procedures. |
