- Email: [email protected]
Internationalism
J Waye
Editorials
as to the impact on patient outcomes and negate the potential of investigator bias. Alternatively, all patients could undergo ERC and IDUS, but therapy would be randomized to that decided after ERC alone versus that decided after the combined procedure. Am I a believer in IDUS? I must admit that I am far more confident as to the ease, accuracy, and efficiency of IDUS. The resolution of the high-frequency probes and the classic echogenic defects with acoustic shadows that characterize stones as small as 2 mm are highly dependable features. Such technology always comes with a price, in this case approximately $3000 per probe, which should last for about 30 examinations with careful handling. The probes can be used with existing EUS processors or with a relatively inexpensive stand-alone dedicated image processor and motor drive, which costs around $30,000 and can substitute for the more expensive EUS endoscope processors. Whether the investment is worth the return depends on your vantage point or perhaps the quality of your fluoroscopy! Gregory B. Haber, MD, FRCP(C) The Centre for Therapeutic Endoscopy and Endoscopic Oncology St. Michael’s Hospital, University of Toronto Toronto, Ontario Canada
Internationalism American endoscopists are rightfully proud of their membership in the American Society for Gastrointestinal Endoscopy. The ASGE is without doubt, the endoscopic organization with the greatest esteem worldwide. The ASGE is a major participant in the annual Digestive Disease Week (DDW) meetings, which are renowned as the premier meeting for international gastroenterologists because they encompass endoscopy, gastroenterology, liver disease, surgery, research, and education. Gastrointestinal Endoscopy also enjoys the reputation as being the premier vehicle of endoscopic communication and information for GI endoscopy. The ascendancy of American gastroenterology and GI endoscopy has not been lost upon our international colleagues, many of whom attend DDW annually. The most recent reports from the American Gastroenterological Association are that almost half of the 15,000 participants in 2002 were registered from lands outside of the United States. The international community wants to be exposed to and Copyright © 2003 by the American Society for Gastrointestinal Endoscopy 0016-5107/2003/$30.00 + 0 doi:10.1067/mge.2003.83 714
GASTROINTESTINAL ENDOSCOPY
REFERENCES 1. Catanzaro A, Pfau P, Isenberg GA, Wong RCK, Sivak MV Jr, Chak A. Clinical utility of intraductal ultrasound in evaluating choledocholithiasis. Gastrointest Endosc 2003;57:648-52. 2. Chak A, Isenberg G, Kobayashi K, Wong RCK, Sivak MV Jr. Prospective evaluation of an over-the-wire catheter US probe. Gastrointest Endosc 2000;51:202-4. 3. Das A, Isenberg G, Wong RCK, Sivak MV Jr, Chak A. Wire guided intraductal US: an adjunct to ERCP management of bile duct stones. Gastrointest Endosc 2001;54:31-6. 4. Tseng LJ, Jao YTFN, Mo LR, Lin RC. Over-the-wire US catheter probe as an adjunct to ERCP in the detection of choledocholithiasis. Gastrointest Endosc 2001;54:720-3. 5. Frossard JL, Hadengue A, Amouyal G, Choury A, Marty O, Giostra E, et al. Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc 2000;51:175-9. 6. Oria A, Alvarez J, Chiapetta L, Fontana JJ, Iovaldi M, Paladini A, et al. Risk factors for acute pancreatitis in patients with migrating gallstones. Arch Surg 1989;124:12956. 7. Berdah SV, Orsoni P, Barthet M, Grimaud JC, Picaud R. Follow-up of selective endoscopic ultrasonography and /or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients. Endoscopy 2001;33:216-20. 8. Liu CH, Lo CM, Chan JKF, Poon RTP, Lam CM, Fan ST, et al. Detection of choledocholithiasis by EUS in acute pancreatitis: a prospective evaluation of 100 consecutive patients. Gastrointest Endosc 2001;54:325-30.
learn about the latest advances in GI endoscopy. They want to publish their best research in the most prestigious journal, Gastrointestinal Endoscopy. Not only do we have information to share with our international colleagues, but our international colleagues in turn, have much to teach us in America. When I have attended live endoscopy courses in Canada, Spain, UK, Belgium, The Netherlands, France, India, Russia, Japan, China, Australia, Chile, Argentina, Brazil, Paraguay, and Mexico, I have seen that the practice of endoscopy throughout the world is at an extremely high level. This may seem unusual to Americans, who are used to exporting intellectual material and do not readily accept the concept of importing knowledge from other countries. Although we have much to teach, we have much to learn, especially in the field of endoscopy in which progress is being made in every country throughout the world, often with wellplanned and well-executed studies, with results submitted as high-level scientific articles to journals of gastroenterology. Acceptance for publication is solely based on scientific merit based on peer review. In spite of the competition for publication space in these prestigious journals, good articles keep flowing in from foreign countries because everybody appreciates the special acknowledgement VOLUME 57, NO. 6, 2003
Editorials
that their paper was published in the best journal. The high level of international medicine we see in Gastroenterology and Gastrointestinal Endoscopy is also reflected with the awardees of the Nobel Prize in physiology and medicine, which was not awarded to any Americans from 1901-1930. At the present time, the total number of awardees for the Nobel Prize in physiology and medicine is equally split between recipients living and working in the United States, and those outside of this country. In these days where international travel has lost some of its luster for Americans, it is increasingly important for Americans to reach out to our colleagues in other countries to exchange information. There is no doubt that American medicine is the best in the world because we have the best infrastructure for teaching, research, and education (although all the endoscopes that are used throughout the world are primarily manufactured in Japan and none in the United States). Americans have a moral obligation to share our knowledge and expertise with others. However, the information flow is not a one-way street; cross-fertilization of ideas and knowledge is important because many advances have been developed by our international colleagues. After all, the first papillotomy was performed by groups outside the United States, Meinhard Classen in Germany and Keechi Kawai in Japan.1,2 I recall, with clarity, the visit of Professors Provenzali and Revignas to DDW in 1967, when they discussed3 their technique of using a pulley system anchored on a long string that had been ingested orally and passed rectally, to pull a gastroscope up into the colon for the first demonstration of deep colonoscopy. This presentation captured my thoughts and stimulated me to become involved in colonoscopy, which has become a career in itself. A few years ago, at a meeting in Toronto, I watched Paul Swain from England work with his endoscopic sewing machine4 to stitch together the raveled sleeve of the cardioesophageal junction to stop reflux. The capsule endoscope, which has captured the imagination of endoscopists throughout the world, was also developed by a multinational team from England and Israel5 (Paul Swain and Gavriel Meron from Israel). Three years ago at DDW, Paul Swain reported the first use of the capsule endoscope to a standing ovation of enthusiastic international endoscopists. The whole technique of endoscopic mucosal resection was conceived and developed in Japan6 and the first articles on this technique pointed out its safety and usefulness. I also remember a visit from a young Japanese physician (Dr. H. Mitooka) many years ago, VOLUME 57, NO. 6, 2003
J Waye
who had used the submucosal injection polypectomy technique before it became popular. When I was about to perform a polypectomy, he suggested that I inject saline solution underneath the large flat polyp to elevate it and make it safer and easier to remove. At his suggestion, I did so (with him standing by) and was amazed and delighted at how easy and simple the technique was, and that changed my approach to sessile polyps forever. These are but a few examples in which the ideas and concepts from other countries have and will change the way we perform endoscopy in the United States. With the rapid and fast communication ability throughout the world, Americans cannot afford to be insular. We need to encourage American endoscopists to visit our colleagues throughout the world, and to encourage them to come to the United States to exchange thoughts and techniques. There is nothing quite like seeing a new endoscopic advancement, but the next best learning experience is reading a report of the procedure in a peer-reviewed journal and adopting it into the framework of our current practice. It has been my pleasure to be the International Editor for Gastrointestinal Endoscopy over the past 5 years. I have been fortunate to work with an editorial board of some 40 international members, all of whom are renowned endoscopists, eager to share information with the rest of the world. In the Perspectives section of Gastrointestinal Endoscopy, we have recorded the views of all these international endoscopists, sharing their information on such diverse topics as parasitosis, sedation for endoscopy, handling of emergencies in GI endoscopy, ERCP, capsule endoscopy, and several other issues throughout the years. I, personally, have had a wonderful opportunity to experience firsthand the eagerness and the graciousness of our colleagues to foster internationalism among GI endoscopists. We in the United States are fortunate to have large and modern endoscopy units, the ability to upgrade equipment, the ready access to all of the positive features of DDW, and the ability to share in our journal, Gastrointestinal Endoscopy. Although we have much to share, we have much to learn from our colleagues throughout the world. The GI tract differs little in the inhabitants from country to country. Our knowledge about endoscopy of the GI system expands with every article and every presentation, whether the author is from the United States or any other country. Isolationism has not been a characteristic of Americans for many decades, and there is no place for it in the field of medicine. Gastrointestinal Endoscopy and its editors are proud to present the best information to the readership that can be published. Excellence GASTROINTESTINAL ENDOSCOPY
715
J Waye
Editorials
has no boundaries. Gastrointestinal Endoscopy is pleased to participate in the globalization of information in the field of GI endoscopy. As we share, so do we learn. Jerome D. Waye, MD New York, New York REFERENCES 1. Classen M. Back to the future: the first papillotomy at erlangen. Gastrointest Endosc 2000;51:637-8.
2. Kawai K. In the beginning. Report of endoscopical papillotomy. Gastrointest Endosc 2000;51:367-8. 3. Provenzale L, Revignas A. An original method for guided intubation of the colon. Gastrointest Endosc 1969;16:11-7. 4. Swain CP, Mills TN. An endoscopic sewing machine. Gastrointest Endosc 1986;32:36-8. 5. Meron GD. The development of the swallowable video capsule. Gastrointest Endosc 2000;52:817-9. 6. Kanamori T, Itoh M, Yokayama Y, Tsuchida K. Injection-incision-assisted snare resection of large sessile colorectal polyps. Gastrointest Endosc 1996;43:189-95.
Moving? To ensure continued service please notify us of a change of address at least 6 weeks before your move. Phone Subscription Services at 800-654-2452 (outside the U.S. call 407-345-4000) or fax your information to 407-363-9661.
716
GASTROINTESTINAL ENDOSCOPY
VOLUME 57, NO. 6, 2003
Editorials
as to the impact on patient outcomes and negate the potential of investigator bias. Alternatively, all patients could undergo ERC and IDUS, but therapy would be randomized to that decided after ERC alone versus that decided after the combined procedure. Am I a believer in IDUS? I must admit that I am far more confident as to the ease, accuracy, and efficiency of IDUS. The resolution of the high-frequency probes and the classic echogenic defects with acoustic shadows that characterize stones as small as 2 mm are highly dependable features. Such technology always comes with a price, in this case approximately $3000 per probe, which should last for about 30 examinations with careful handling. The probes can be used with existing EUS processors or with a relatively inexpensive stand-alone dedicated image processor and motor drive, which costs around $30,000 and can substitute for the more expensive EUS endoscope processors. Whether the investment is worth the return depends on your vantage point or perhaps the quality of your fluoroscopy! Gregory B. Haber, MD, FRCP(C) The Centre for Therapeutic Endoscopy and Endoscopic Oncology St. Michael’s Hospital, University of Toronto Toronto, Ontario Canada
Internationalism American endoscopists are rightfully proud of their membership in the American Society for Gastrointestinal Endoscopy. The ASGE is without doubt, the endoscopic organization with the greatest esteem worldwide. The ASGE is a major participant in the annual Digestive Disease Week (DDW) meetings, which are renowned as the premier meeting for international gastroenterologists because they encompass endoscopy, gastroenterology, liver disease, surgery, research, and education. Gastrointestinal Endoscopy also enjoys the reputation as being the premier vehicle of endoscopic communication and information for GI endoscopy. The ascendancy of American gastroenterology and GI endoscopy has not been lost upon our international colleagues, many of whom attend DDW annually. The most recent reports from the American Gastroenterological Association are that almost half of the 15,000 participants in 2002 were registered from lands outside of the United States. The international community wants to be exposed to and Copyright © 2003 by the American Society for Gastrointestinal Endoscopy 0016-5107/2003/$30.00 + 0 doi:10.1067/mge.2003.83 714
GASTROINTESTINAL ENDOSCOPY
REFERENCES 1. Catanzaro A, Pfau P, Isenberg GA, Wong RCK, Sivak MV Jr, Chak A. Clinical utility of intraductal ultrasound in evaluating choledocholithiasis. Gastrointest Endosc 2003;57:648-52. 2. Chak A, Isenberg G, Kobayashi K, Wong RCK, Sivak MV Jr. Prospective evaluation of an over-the-wire catheter US probe. Gastrointest Endosc 2000;51:202-4. 3. Das A, Isenberg G, Wong RCK, Sivak MV Jr, Chak A. Wire guided intraductal US: an adjunct to ERCP management of bile duct stones. Gastrointest Endosc 2001;54:31-6. 4. Tseng LJ, Jao YTFN, Mo LR, Lin RC. Over-the-wire US catheter probe as an adjunct to ERCP in the detection of choledocholithiasis. Gastrointest Endosc 2001;54:720-3. 5. Frossard JL, Hadengue A, Amouyal G, Choury A, Marty O, Giostra E, et al. Choledocholithiasis: a prospective study of spontaneous common bile duct stone migration. Gastrointest Endosc 2000;51:175-9. 6. Oria A, Alvarez J, Chiapetta L, Fontana JJ, Iovaldi M, Paladini A, et al. Risk factors for acute pancreatitis in patients with migrating gallstones. Arch Surg 1989;124:12956. 7. Berdah SV, Orsoni P, Barthet M, Grimaud JC, Picaud R. Follow-up of selective endoscopic ultrasonography and /or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients. Endoscopy 2001;33:216-20. 8. Liu CH, Lo CM, Chan JKF, Poon RTP, Lam CM, Fan ST, et al. Detection of choledocholithiasis by EUS in acute pancreatitis: a prospective evaluation of 100 consecutive patients. Gastrointest Endosc 2001;54:325-30.
learn about the latest advances in GI endoscopy. They want to publish their best research in the most prestigious journal, Gastrointestinal Endoscopy. Not only do we have information to share with our international colleagues, but our international colleagues in turn, have much to teach us in America. When I have attended live endoscopy courses in Canada, Spain, UK, Belgium, The Netherlands, France, India, Russia, Japan, China, Australia, Chile, Argentina, Brazil, Paraguay, and Mexico, I have seen that the practice of endoscopy throughout the world is at an extremely high level. This may seem unusual to Americans, who are used to exporting intellectual material and do not readily accept the concept of importing knowledge from other countries. Although we have much to teach, we have much to learn, especially in the field of endoscopy in which progress is being made in every country throughout the world, often with wellplanned and well-executed studies, with results submitted as high-level scientific articles to journals of gastroenterology. Acceptance for publication is solely based on scientific merit based on peer review. In spite of the competition for publication space in these prestigious journals, good articles keep flowing in from foreign countries because everybody appreciates the special acknowledgement VOLUME 57, NO. 6, 2003
Editorials
that their paper was published in the best journal. The high level of international medicine we see in Gastroenterology and Gastrointestinal Endoscopy is also reflected with the awardees of the Nobel Prize in physiology and medicine, which was not awarded to any Americans from 1901-1930. At the present time, the total number of awardees for the Nobel Prize in physiology and medicine is equally split between recipients living and working in the United States, and those outside of this country. In these days where international travel has lost some of its luster for Americans, it is increasingly important for Americans to reach out to our colleagues in other countries to exchange information. There is no doubt that American medicine is the best in the world because we have the best infrastructure for teaching, research, and education (although all the endoscopes that are used throughout the world are primarily manufactured in Japan and none in the United States). Americans have a moral obligation to share our knowledge and expertise with others. However, the information flow is not a one-way street; cross-fertilization of ideas and knowledge is important because many advances have been developed by our international colleagues. After all, the first papillotomy was performed by groups outside the United States, Meinhard Classen in Germany and Keechi Kawai in Japan.1,2 I recall, with clarity, the visit of Professors Provenzali and Revignas to DDW in 1967, when they discussed3 their technique of using a pulley system anchored on a long string that had been ingested orally and passed rectally, to pull a gastroscope up into the colon for the first demonstration of deep colonoscopy. This presentation captured my thoughts and stimulated me to become involved in colonoscopy, which has become a career in itself. A few years ago, at a meeting in Toronto, I watched Paul Swain from England work with his endoscopic sewing machine4 to stitch together the raveled sleeve of the cardioesophageal junction to stop reflux. The capsule endoscope, which has captured the imagination of endoscopists throughout the world, was also developed by a multinational team from England and Israel5 (Paul Swain and Gavriel Meron from Israel). Three years ago at DDW, Paul Swain reported the first use of the capsule endoscope to a standing ovation of enthusiastic international endoscopists. The whole technique of endoscopic mucosal resection was conceived and developed in Japan6 and the first articles on this technique pointed out its safety and usefulness. I also remember a visit from a young Japanese physician (Dr. H. Mitooka) many years ago, VOLUME 57, NO. 6, 2003
J Waye
who had used the submucosal injection polypectomy technique before it became popular. When I was about to perform a polypectomy, he suggested that I inject saline solution underneath the large flat polyp to elevate it and make it safer and easier to remove. At his suggestion, I did so (with him standing by) and was amazed and delighted at how easy and simple the technique was, and that changed my approach to sessile polyps forever. These are but a few examples in which the ideas and concepts from other countries have and will change the way we perform endoscopy in the United States. With the rapid and fast communication ability throughout the world, Americans cannot afford to be insular. We need to encourage American endoscopists to visit our colleagues throughout the world, and to encourage them to come to the United States to exchange thoughts and techniques. There is nothing quite like seeing a new endoscopic advancement, but the next best learning experience is reading a report of the procedure in a peer-reviewed journal and adopting it into the framework of our current practice. It has been my pleasure to be the International Editor for Gastrointestinal Endoscopy over the past 5 years. I have been fortunate to work with an editorial board of some 40 international members, all of whom are renowned endoscopists, eager to share information with the rest of the world. In the Perspectives section of Gastrointestinal Endoscopy, we have recorded the views of all these international endoscopists, sharing their information on such diverse topics as parasitosis, sedation for endoscopy, handling of emergencies in GI endoscopy, ERCP, capsule endoscopy, and several other issues throughout the years. I, personally, have had a wonderful opportunity to experience firsthand the eagerness and the graciousness of our colleagues to foster internationalism among GI endoscopists. We in the United States are fortunate to have large and modern endoscopy units, the ability to upgrade equipment, the ready access to all of the positive features of DDW, and the ability to share in our journal, Gastrointestinal Endoscopy. Although we have much to share, we have much to learn from our colleagues throughout the world. The GI tract differs little in the inhabitants from country to country. Our knowledge about endoscopy of the GI system expands with every article and every presentation, whether the author is from the United States or any other country. Isolationism has not been a characteristic of Americans for many decades, and there is no place for it in the field of medicine. Gastrointestinal Endoscopy and its editors are proud to present the best information to the readership that can be published. Excellence GASTROINTESTINAL ENDOSCOPY
715
J Waye
Editorials
has no boundaries. Gastrointestinal Endoscopy is pleased to participate in the globalization of information in the field of GI endoscopy. As we share, so do we learn. Jerome D. Waye, MD New York, New York REFERENCES 1. Classen M. Back to the future: the first papillotomy at erlangen. Gastrointest Endosc 2000;51:637-8.
2. Kawai K. In the beginning. Report of endoscopical papillotomy. Gastrointest Endosc 2000;51:367-8. 3. Provenzale L, Revignas A. An original method for guided intubation of the colon. Gastrointest Endosc 1969;16:11-7. 4. Swain CP, Mills TN. An endoscopic sewing machine. Gastrointest Endosc 1986;32:36-8. 5. Meron GD. The development of the swallowable video capsule. Gastrointest Endosc 2000;52:817-9. 6. Kanamori T, Itoh M, Yokayama Y, Tsuchida K. Injection-incision-assisted snare resection of large sessile colorectal polyps. Gastrointest Endosc 1996;43:189-95.
Moving? To ensure continued service please notify us of a change of address at least 6 weeks before your move. Phone Subscription Services at 800-654-2452 (outside the U.S. call 407-345-4000) or fax your information to 407-363-9661.
716
GASTROINTESTINAL ENDOSCOPY
VOLUME 57, NO. 6, 2003