| Invited Lecture(JGES) |
| Thu. October 31st 14:00 - 14:30 Room 4: Portopia Hotel South Wing Portopia Hall |
| What should the West learn from Japan in the field of endoscopy and what should Japan learn from the West? | |||
| Thierry Ponchon | |||
| Lyon University | |||
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| This is an excellent question in the era of globalization and rapid exchanges between countries and between continents. As an introduction, I express three thoughts: 1) West has more to learn from Japan than Japan from the West in endoscopy. 2) it is certainly important to develop exchanges and that West learns from Japan or that Japan learns from West. But we must certainly be careful not to evolve too much towards a standardization of practices and especially of research. Japan must remain Japan and West must remain West. 3) What I write about endoscopy is also valid for many areas especially for culture and the art of living. Japan has greatly influenced West and vice versa. But Japan should nevertheless preserves its specificity. What West should learn from Japan: Japanese colleagues have played a major role in the advent of digestive endoscopy and continue to greatly influence the development of this field. This influence is not simply linked to the technology developed and supplied by the three main Japanese endoscope companies. This influence is linked to the particular character traits of the Japanese people and in particular of expert or non-expert Japanese endoscopists (according to my point of view as a modest European endoscopist): innovation, precision, skill, deduction. There is a real Japanese school of endoscopy on the diagnostic level and therapeutic level. The most impressive character trait of Japanese endoscopists concerns the characterization of mucosal lesions: the final diagnosis is given after a careful and systematic analysis of all the details of the image. And not with a simple glance as Western endoscopists often do. The Japanese are deductive while Westerners are intuitive. Similarly, concerning detection, Japanese endoscopists not only analyze relief anomalies like Western endoscopists but also analyze color changes. There are also other favorite subjects of Japanese endoscopists that Western endoscopists must learn: 1- to produce very high quality images and videos, precise, sharp, with multiple perspectives and if necessary an adapted chromoendoscopy. 2- to confront endoscopic images with histological images during consensus meetings conducted with histopathologists. 3- to describe a procedure step by step and teach each of these steps meticulously and precisely. As it is the case for submucosal dissection for example. 4- to develop an intellectual curiosity for new technologies and new techniques not only because they are new but because they are applicable and useful. I finally believe that the main characteristic of Japanese endoscopy is to know how to dissect in all these details a diagnosis and a treatment. What Japan can learn from West: there are few weaknesses in Japanese endoscopy. For example, the quality of methodology during experimental research or clinical research has improved considerably in Japan and has largely reached an excellent level (prospective randomized studies, IRB approval, sample size calculations, statistics,...) Western endoscopists can nevertheless draw the attention of their Japanese colleagues to two subjects: the duration and cost of procedures, the simplification of classifications. Quality is the priority for a Japanese endoscopy but it may be that this quality is detrimental to the diffusion of techniques and their use if the procedures are too long or too expensive. Health has a cost and it is important that this cost is taken into account for political and economic reasons on a country scale. The consideration of this cost is certainly exaggerated in Western countries but probably underestimated in Japan. Concerning classifications, their number and complexity is linked to the detailed analysis of lesions by a Japanese endoscopist as I described above. But when you know a little about Japan you realize that there are different great institutions in Japan that can be in competition but to diffuse its knowledge to the West, Japan must go through a stage of standardization and simplification. Which is starting to happen. Finally, Japan has dominated the world of endoscopy with its contributions to the diagnosis of superficial digestive lesions, treatment by mucosectomy and dissection. But these techniques are beginning to spread widely and in order to continue to influence endoscopy in the future, Japan must invent new advances. The West has already made great progresses in endoscopic ultrasound and artificial intelligence. |
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