Clinical Exchange in Japan

I applied to come to Nagoya medical school for my elective period as I am greatly interested in both the diagnosis and treatment of upper gastrointestinal cancers. As Nagoya is a tertiary referral centre for endoscopic and surgical treatment of a wide range of upper GI cancers and is very active in clinical research, this was a fantastic opportunity to observe both of these aspects from the Japanese clinicians who are experts in this field.

For the first four weeks of my elective, I was staying in the department of endoscopy in the university hospital. This was a very busy department, which undertook screening and treatment of oesophageal, gastric, pancreatic and hepatic carcinomas. On my first day I was taken care of by a doctor who spoke English (luckily for me as my Japanese was initially extremely limited!) who introduced me to all of the doctors in the team and explained to me the procedures. During the first week, I was observing all of the various teams (gastric, hepatic and pancreaticobiliary) to gain an overview of all of the work that the department does before deciding which team to follow for the remaining three weeks. As I am very interested in gastric and oesophageal cancer, I chose to follow the upper GI gastric team who were extremely adept in identifying very early upper GI cancer (which is extremely difficult to see) using a variety of techniques. The doctors in the team were very friendly and helpful, explaining to me the various dyes and imagining techniques used. I saw many examples of gastric cancer in both early and late stage, in addition to stromal tumours, anastomotic leaks from surgery and many others. I was also fortunate to see many ESD procedures, which are not currently routinely performed in the UK, which are used as definitive treatment for early superficial carcinomas. Some of the doctors also took time in the afternoon to train me in using the endoscope on models of the stomach and colon, which is much more difficult than it seems!

For the remaining two weeks of my elective I was assigned to the department of gastrointestinal surgery, to see the surgical management of more advanced cancers of the upper GI system. This department was very busy, performing major operations on a daily basis. This department was also extremely friendly, explaining to me surgical procedures, taking me on surgical ward rounds and to try some of the amazing food japan has to offer in the evenings! I was also able to attend a suture workshop with other Nagoya medical students and research presentations made by the surgical team who are also very active in research.

Coming to Nagoya was a fantastic experience and I am extremely grateful to the staff who took care of me during my stay and made the experience fun and rewarding, in particular Dr. Chantarojanasiri and Professor Kodera who made me very welcome in both departments and made my stay very memorable.

During my stay I was also lucky enough to have the combination of beautiful weather and the hanami (flower viewing) season which I saw in both Nagoya and Kyoto. I was also able to practice and learn more Japanese than I expected, mostly due to how friendly many Japanese were and their patience in understanding my poor Japanese! Nagoya is a beautiful city with many things to do, a friendly university and a busy university hospital that is strong in research. I would strongly recommend anyone thinking of coming to Asia for their elective to choose Japan and Nagoya.

Brett Ibbeson – Rotation in department of gastroenterology/gastroenterological surgery from March to April 2015.