Around the world 50 years ago. Part 3 Japan

I arrived in Tokyo at last on  May  23rd.

For my non-medical readers (if there are any, I thank you), I should explain again that my reason for being in Japan was to explore their progress in the development and use of flexible fiberoptic endoscopes to examine the human guts (esophagus, stomach and intestines, small and large). Many people nowadays, at least older ones, are familiar (some intimately) with colonoscopes, that are used to screen for and treat polyps and tumors in the colon. Japanese companies were pioneers in this field, and Olympus remains so. The stimulus for this visit was the news that some doctors were using prototype instruments to get beyond the stomach and into the bile duct (draining the liver) and the pancreas, in order to inject dyes and to take Xray pictures. This was a truly revolutionary idea, long before modern imaging tools like ultrasound and CT scans.  The pioneers were Itaru Oi (Tokyo Women’s Medical College), Tatsuzo Kasugai (Nagoya) and my soon to be teacher Kasuei Ogoshi in Niigata.

The Olympus company had kindly arranged my schedule and leant me a guide, young Mr Ofuji. That was fortunate, indeed essential, for very few people spoke English, and my Japanese never advanced beyond a few basic phrases.

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I spent the first few days in Tokyo, based at the New Otani hotel, and visited the endoscopy units of the Tokyo University Branch Hospital (Dr Fujita) and Tokyo Women’s Medical College (Dr Oi).

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Very impressed with their departments, equipment and staff. In those days, gastrocameras were popular for screening for gastric cancer, a big problem in Japan. This instrument had a tiny camera and roll of film in the tip. It produced good pictures, which the Japanese pored over for hours looking for the earliest signs of neoplasia. They were reluctant to give up that feature, so the next iteration was a combined endoscope with inbuilt camera, the GTF.

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For those involved in endoscopy nowadays it is interesting to reflect that we again use internal cameras, now swallowed rather than inserted. They transmit pictures as they travel though the guts. Amazing technology. The first ones were made in Israel collaborating with an innovative British doctor, Paul Swain

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Of course, my main focus was on the new prototype duodenoscopes, which were in use in both units. I saw and marvelled at several cases of what they called 膵胆管造影, or ECPG (Endoscopic CholangioPancreatoGraphy)

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My last evening in Tokyo was spent at the British Embassy, celebrating the Queen’s birthday, taken there by a former classmate in a green Rolls Royce borrowed from the Ambassador. The contrast between the grey city and the colorful Victorian party was impressive, and the gin flowed. I remember feeling slightly sluggish when catching the train to Niigata next morning.

Here is Dr Ogoshi’s kind letter of invitation to Niigata, that I received while in Iran

And my first impressions

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I was met by Dr Ogoshi and his boss, Professor Hara. Someone said that the procedure was so difficult that it could be performed only by Japanese musicians. Kazuei had that talent, but I certainly did not

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They were both exemplary hosts. We went straight from the train to a restaurant and moved into a large selection of raw fish. that is now a favorite, but then rather a surprise and a significant challenge. Maybe it was a test.

I spent 10 days in Niigata, mostly in the endoscopy unit, learning that it was indeed (just) possible to do the new procedure. Kazeui was a great teacher

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One weekend I went with Kazuei and his family to a local park that was celebrating the carp festival “Koinobori” with lots of fishy flags.

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Prof Hara was a keen golfer and took me out to play at his local course. He called himself “friend of bunker” presumably because he spent much time in them, and often had to throw his ball out. I later bought him a book on bunker play as a leaving present, but he seemed suprised that I thought he might need one.

Kazuei was kind enough to write about my visit 25 years later. We have kept in touch. I visited Niigata some years ago when he was President of the Japanese Endoscopy society, and he came once to Duke and later to Charleston as my guest at one of our “beach meetings”.

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He was kind enough to write about my visit 25 years later.

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He was among the pioneers who named ERCP at the Mexico City World Congress in 1974

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So, back to Tokyo and a schedule organized again by Olympus, including a trip south on the bullet train to ancient Kyoto and to Dr Kasugai’s unit. All fascinating.

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Then back to Tokyo

June 13.  さよなら (sayonara) Japan, and thank you. Next stop USA……