Department of Gastroenterological Medicine

Consultation Guide

Regarding endoscopic diagnosis/ treatment of early-stage alimentary canal cancer

In our department, there is a total of 5 staff members engaged in endoscopic medical care, including 2 medical specialists of digestive endoscopy. Our motto is to provide our patients with endoscopic examination which causes little pain. At patients’ request, we serve sedation to them by applying intravenous anesthesia in all cases. Especially in cases of colonoscopic examination, we perform endoscopic examination that causes little pain to patients, by using immersion testing to insert an endoscope, or supplying carbon-rich gas. Extirpation of colonic polyp is completed in one day. The upper and lower alimentary canal examination can be served at the same time, so please consult us when you undergo examination of the digestive tract as part of a through medical checkup or examination.
Regarding Endoscopic Submucosal Dissection (ESD): Surgical procedure has been the first choice in cancer treatment but with the growing availability of colonoscopic examination and gastric camera used in health exam and a through medical check up, the discovery rate of early stage cancer has increased, enabling patients to choose less invasive therapies. Especially leading the world in the field of stomach cancer which is relatively popular among Japanese people, it has devised a method of Endoscopic submucosal dissection enabling us to remove the lesion which had been difficult to be removed at one time in endoscopic resection. In 2007, early stomach cancer was covered by health insurance, followed by early esophageal cancer in 2009 and early bowel cancer in 2012.
In the department, we take responsibility for performing treatment such as, preoperative diagnosis, endoscopic resection, examination of degree of complete recover and in case of stomach cancer, pylorus eradication after the radical excision, and periodical follow-ups after the surgery.

Endoscopic diagnosis/Treatment for bile passage and pancreatic disease

As the population ages, bile duct stone, endoscopic diagnosis and pancreas malignancy are becoming popular diseases among people. We perform palliative treatment such as, gastroenterological endoscopic treatment for acute cholangitis and bile duct stone, endoscopic stent placement for biliary obstruction caused by malignant tumor. With introduction of ultrasound endoscope and small-bowel endoscopy, we will continue making efforts in expanding our services so that we can respond to further pathological lesions.

Palliative chemotherapy/ supportive care for advanced cancer

As the population ages, we are now living in an age where 1 out of 3 people die of cancer, and 1 out of 2 people develops cancer at least once in their entire life times. With that, there is also an increase in a number of patients who are diagnosed with advanced cancer difficult to be cured completely. Cancers of digestive system account for about half its ratio of them, particularly bowel cancer and pancreas cancer are on the rise. Even with these intractable and advanced cancers, the ratio of survival has improved by applying combined modality therapy which combines surgical therapy, anticancer drug treatment and radiation therapy. Especially in the field of anticancer drug, there has been an improvement in treatment results for cancers which had no effective treatment in the past, with molecularly-targeted therapeutic medicine being continuously developed and applied in a clinical setting. Also, side effects used to be difficult for patients have been eased by an improvement in supportive care, making patients able to continue treatment while maintaining to spend a ordinary life. However, standard treatmensts and adaptation in cancer treatment differ according to its original organ caused cancer, and the degree of progress, and they are advanced quickly, the importance of team medical care is being pointed out, to deal with growing complication and specialization in the treatment.
In our department, we aim to provide each patient with the best treatment possible by coordinating closely with the trauma department,the department of gastroenterological medicine, the department of general medicine, and allied health professionals.
In cases where radiation therapy is necessary, we serve it in cooperation with the department of radiation therapy/oncology center, Shonan Kamakura General Hospital, Okinawa Tokushukai healthcare corporation.

n this department, We provide standard chemotherapy on based on latest evidence (scientific underpinnings) for diseases listed below.

●Esophageal cancer:
  • Neo-adjuvant chemotherapy for resectable/ advanced cancer, and palliative chemotherapy for resectable/relapsed advanced cancer.
●Stomach cancer
  • Postoperative adjuvant chemotherapy for postexcisional advanced cancer and palliative chemotherapy for unresectable/ advanced cancer.
●Bowel cancer
  • postoperative adjuvant chemotherapy, advanced cancer and palliative chemotherapy for resectable/ relapsed advanced cancer,
●Pancreatic cancer
  • Postoperative adjuvant chemotherapy for resectable, advanced cancer and palliative chemotherapy for unresectable/ advanced cancer.
●Biliary cancer
  • Palliative chemotherapy for unresectable/ advanced cancer.
●Breast cancer
  • Postoperative adjuvant chemotherapy, hormonal therapy, and palliative chemotherapy for advanced/ relapsed cancer.
●Lung cancer
  • Palliative chemotherapy for unresectable, advanced cancer
●Primary unknown cancer
  • Palliative chemotherapy for unresectable, advanced cancer
●Soft tissue tumor
  • Postoperative adjuvant chemotherapy for resectable gastrointestinal mesenchymal tumor(GIST), palliative chemotherapy for unresectable/ relapsed gastrointestinal mesenchymal tumor(GIST)

About primary doctors/ outpatient department

●Consultation regarding gastroenterological endoscopy: Yamanaka(gastroenterological medicine), Nakayama(tumor of digestive system and internal medicine)
● Consultation regarding endoscopic therapy for cancers in early stage: Yamanaka(gastroenterological medicine), Nakayama(tumor of digestive system and internal medicine), Terashima(trauma department)
●Consultation regarding chemotherapy for advanced cancer: Kuroki/Yasui/Terashima (trauma department), Nakayama (tumor of digestive system and internal medicine)
●Consultation regarding diagnosis/treatment of imflammatory bowel disease(ulcerative colitis, Crohn disease): Yamanaka(gastroenterological medicine) Nakayama(tumor of digestive system and internal medicine)
●Consultation regarding diagnosis/treatment of chronic hepatitis: Yamanaka(gastroenterological medicine),Uoshima(general medicine,ShonanKamakura General Hospital)

For more details, please refer to the table of outpatient clinician in charge. We are willing to offer consultation irrespective of first/second opinions.

Regarding recruitment of senior doctor in training

In this department, we have a policy to practice professional education under the treatmentystems focused on provising overall treatment, in cooporation with the department of general medicine, and the trauma department. We widely recruit doctors with interests in cancer chemotherapy/palliative therapy and endoscopic therapy who are able work as subspecialists regardless of their own specialty (internal medicine specialist/ surgeon). Our focus is on doctors who were graduated from the medical school 3 to 5 years ago. The training period will be 3 to 5 years(negotiable), aiming at becoming medical specialist certified by The Japanese Society of Gastroenterology and The Japan Gastroenterological Endoscopy Society.

【Authorized facilities】
Educational related facility of The Japanese Society of Internal Medicine, Educational related facility of The Japanese Society of Gastroenterology, Training facility of the Japan Gastroenterological Endoscopy Society

About endoscope-related equipments used in the hospital

 
Upper gastrointestinal endoscope: OLYMPUS GIF-H260,GIF-H260Z,GIF-Q260J
Lower gastrointestinal endscope: OLYMPUS CF-H260,CF-Q260AZI,CF-PQ260AL
Endoscope used for inspection of small-vowel : OLYMPUS SIF-Q260
Endscope used for inspection of biliopancreatic duct: OLYMPUS JF-Q260V
Ultrasonic endoscopes: OLYMPUS EU-ME1,GF-UCT260,UM-2R/3R
Radio-frequency radiation device: ERBE VI0-300D
carbon-rich gas transfer apparatus: OLYMPUS UCR

Statistics

 
【In 2012】
【In 2013】
【In 2014】
Upper gastrointestinal endoscopy
4,359 cases
4,596 cases
4,659 cases
Upper digestive ESD/EMR
27/4 cases
25/6 cases
31/5 cases
Esophageal variceal sclerotherapy
3 cases
14 cases
3 cases
Endoscopic banding
38 cases
52 cases
42 cases
Percutaneous Endoscopic Gastrostomy
21 cases
24 cases
13 cases
Ultrasound endoscopy
10 cases
6 cases
22 cases
Lower gastrointestinal endscopy
1,772 cases
1,919 cases
2,005 cases
Colonoscopic polypectomy
443 cases
495 cases
556 cases
Lower gastrointestinal tract ESD
2 cases
2 cases
4 cases
Large bowel stenting
1 cases
7 cases
4 cases
Endoscopic banding
10 cases
12 cases
8 cases
Small-bowel endoscopy
2 cases
2 cases
9 cases
ERCP
77 cases
120 cases
93 cases
Endoscopic papillotomy
41 cases
72 cases
44 cases
Endoscopic lithotomy
29 cases
41 cases
45 cases
Endoscopic drainage
22 cases
43 cases
27 cases