Greetings
Endoscopy Room is located on the second floor of the hospital, in the Fourth Medical Center, and all eight rooms in the facility are equipped with cutting-edge equipment and a filing system/in-house electronic medical records, so that reports and images can be viewed at all ends of the hospital after the examination, ensuring efficient operation.The number of endoscopic examinations and treatments performed annually reaches approximately 17,000, and through the cooperation of various specialist doctors (Gastroenterology, Gastroenterological Surgery, Respiratory Medicine Thoracic Surgery, thoracic surgery, emergency medicine, General Internal Medicine), nurses, laboratory technicians, and many other paramedical staff, we strive to provide patients with high-quality, painless, cutting-edge endoscopic treatments.
Endoscopy Room
Masashi Matsushima
Overview
Last year (April 2023 to March 2024), our Endoscopy Room performed 11,848 upper gastrointestinal (esophageal, stomach, and duodenal) endoscopies, 3,720 lower gastrointestinal endoscopies, 3 double-balloon enteroscopies, 41 capsule enteroscopies, 603 ERCPs, 343 ultrasound endoscopies, and 513 bronchoscopies, making us one of the largest endoscopy units in university hospitals nationwide. In terms of treatment, we also performed 195 ESD endoscopic submucosal dissections (38 esophageal, 83 stomach, and 74 colonic)1, 1,239 EMR endoscopic mucosal resections, 47 esophageal and gastric variceal sclerotherapy and ligation therapies, 251 emergency endoscopic hemostasis procedures for gastrointestinal bleeding, and 47 endoscopic gastrostomy procedures. Gastrointestinal endoscopy examinations are performed mainly by a staff of eight endoscopy instructors and 19 endoscopy specialists, while bronchoscopy examinations are performed mainly by seven Respiratory Medicine and seven Thoracic Surgery surgeons. In addition, with the cooperation of paramedical staff (six nurses, seven clinical laboratory technicians, two clinical engineers, and five administrative staff), including six endoscopists certified by the Japanese Society of Gastrointestinal Endoscopy, we aim to provide safe, prompt responses and accurate diagnosis and treatment. Referred patients can make examination reservations directly through Regional Medical Collaboration Office.
Main target diseases
Endoscopy Room is an open-system facility centered on Respiratory Medicine and surgery, Gastroenterology and surgery, and General Internal Medicine, and in principle, each department has a set day for each test, but for special tests, emergency tests, and endoscopic treatments, we cooperate as needed. For details on the results and diagnostic rates for each disease, please refer to the medical guide for each department. Here, we will mainly introduce the testing and treatment work that is carried out on a daily basis in Endoscopy Room.
In Endoscopy Room, upper gastrointestinal endoscopy, lower gastrointestinal endoscopy, digestive function tests, and endoscopic ultrasound examinations are performed for various gastrointestinal diseases, and bronchoscopy is performed for respiratory diseases.We are proud to say that our number of examination cases and diagnostic rate are among the best in the country.
The characteristics of the examinations and treatments offered by each department are described below.
Bronchoscopy
In recent years, the importance of bronchoscopy has become increasingly recognized due to the rise in pulmonary malignancies and interstitial pneumonia. Our hospital is a certified facility by the Japan Society for Respiratory Endoscopy, and performs over 500 examinations annually under the supervision of bronchoscopy instructors and specialists. Bronchoscopy is used to diagnose pulmonary malignancies, diffuse lung diseases such as interstitial pneumonia, pulmonary tuberculosis, and other infectious diseases of unknown etiology. For lung cancer in particular, we offer proactive diagnostic techniques, including ultrasound-guided biopsy (EBUS-guided sheath method) for peripheral lung lesions and needle biopsy (EBUS-TBNA method) for lymph node metastasis. We also perform bronchoscopy for postoperative endobronchial observation, evaluation of the effectiveness of radiation therapy and chemotherapy, and screening for patients with unexplained cough and hemoptysis. In addition to these diagnostic tests, we also perform treatments using bronchoscopic techniques such as EWS bronchial embolization for intractable pneumothorax, removal of bronchial foreign bodies, stent insertion for airway stenosis, and ablation using argon plasma coagulation (APC).
Gastroenterology
digestive diseases
We provide comprehensive and specialized medical care for the entire digestive tract, from the esophagus to the stomach, duodenum, small intestine, and rectum.
Currently, the department has 5 Japan Gastroenterological Endoscopy Society instructors, 13 specialists, 8 Japan Gastroenterological Association instructors, and 14 specialists, with the 9 members of the gastrointestinal group providing medical care.For highly specialized procedures, we work closely with staff Endoscopy Room, radiography room, and operating room as needed, and also cooperate with other departments such as diagnostic radiology, Department of Radiation Therapy, surgery, and Department of Diagnostic Pathology to provide multidisciplinary medical care.
For gastrointestinal tumors, we use image-enhanced observation, magnifying endoscopy, and ultrasound endoscopy to make more accurate preoperative diagnoses and select appropriate treatment methods.For tumors that are primarily confined to the mucosa, from the esophagus to the stomach, duodenum, and large intestine, we actively perform endoscopic treatments (endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), etc.) for early cancers and precancerous lesions.For submucosal tumors, we perform incisional biopsy or endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for tissue diagnosis.
Inflammatory bowel diseases (ulcerative colitis, Crohn's disease), which have been increasing in number in recent years, are being treated by utilizing various diagnostic imaging techniques, including capsule and small bowel endoscopy, in an effort to accurately understand the pathology of these diseases.
We also provide emergency endoscopy to stop bleeding in cases of gastrointestinal bleeding and handle emergency cases such as foreign bodies.
Hepatobiliary and pancreatic diseases
For esophageal and gastric varices, we perform endoscopic treatments such as endoscopic variceal sclerotherapy (EIS) and endoscopic variceal ligation (EVL), both for emergency and preventive cases. We also provide comprehensive treatment for the underlying liver cirrhosis, including nutritional management before and after treatment and liver metabolism and hemodynamics. Furthermore, for intractable cases, we perform interventional treatments (B-RTO, PSE, and TIPS) under angiography, achieving high therapeutic effectiveness. Regarding endoscopic examinations and treatments for biliary and pancreatic diseases, we use various imaging tests for cholelithiasis, as well as endoscopic retrograde cholangiopancreatography (ERCP) to accurately identify the type, size, and number of stones, before deciding on treatment options. For common bile duct stones, we perform endoscopic biliary drainage (EBD) followed by endoscopic endoscopic stenosis (EST) or endoscopic papillotomy (EPBD) followed by stone removal, achieving favorable outcomes. In cases of obstructive jaundice caused by biliary or pancreatic tumors, we promptly perform percutaneous biliary drainage (PTBD) or endoscopic biliary drainage (EBD), and in cases where surgery is not possible, we perform multidisciplinary treatment for gastrointestinal cancer after stent insertion, striving to extend the patient's survival rate and improve their quality of life.
Gastroenterological Surgery
In the field of gastrointestinal tract, we are mainly divided into three specialized groups: upper, hepatobiliary, and pancreatic, and lower, and each group works together with internal medicine and other surgical groups to carry out examinations and treatments.
1. upper gastrointestinal tract
Our diagnostic services range from screening examinations of the esophagus, stomach, and duodenum, to preoperative diagnosis of upper gastrointestinal diseases using chromoendoscopy, to endoscopic ultrasound to diagnose tumor depth and lymph node metastasis. We also strive to detect secondary cancers (especially esophageal cancer) in head and neck cancer patients through collaboration with otolaryngology and oral surgery. Endoscopic treatments include EIS and EVL for esophageal varices, and we actively perform endoscopic mucosal resection (EMR) and submucosal dissection (ESD) as minimally invasive radical treatments for esophageal and gastric mucosal cancer. Our endoscopic mucosal resection (EMR) for esophageal mucosal cancer is a pioneering technique worldwide.
2. Liver, gallbladder and pancreas
In endoscopic examinations in the hepato-biliary-pancreatic field, ERCP is the main method used for routine examinations of the gallbladder and pancreas (especially for preoperative diagnosis of cholelithiasis and malignant tumors). We also actively perform examinations of the biliary tract and pancreatic duct using ultrasound endoscopes and narrow endoscopes. As for therapeutic endoscopy, we perform ENBD for obstructive jaundice in approximately 50 cases per year. After reducing the amount of jaundice, we have recently been actively performing endoscopic papillary balloon dilation (EPBD). Depending on the case, we may choose to perform EST or stent insertion.
3. lower gastrointestinal tract
Traditionally, barium enema X-ray (LGI) was the first choice for colorectal cancer screening. However, with the recent widespread adoption of total colonoscopy (TCS), efforts have shifted to proactively removing polyps 5mm or larger as precancerous lesions in an effort to prevent colorectal cancer. While TCS has some weaknesses compared to LGI, such as its inability to grasp the overall picture, its usefulness goes without saying, including its ability to identify minute lesions and diagnostic treatments such as polypectomy, endoscopic mucosal resection, and submucosal dissection (ESD). In our department, TCS is often completed in 10–20 minutes, often without medication or with only a slight sedative. This examination, primarily performed as an outpatient, is performed approximately 50 times per week, for a total of 2,681 cases per year. We also actively perform EMR and laparoscopic (subcutaneous) surgery for early-stage colorectal cancer.
4. Other
Although less common, we also perform examinations such as pediatric endoscopic examinations (mainly Pediatric Surgery) and transesophageal cardiac ultrasound (Cardiology and Cardiovascular Surgery).