Call for International Fellow Applications

The training programs for international fellows are fantastic. Dr. Ohata’s team put much efforts on the
courses. Aside from a bunch of colorectal, gastric, esophageal, and duodenal ESD, there are lectures
once every week, and hands-on ESD on porcine model. Here I can watch ESD done not only by experts, but
also by trainees. As a beginner like me, it’s great to see different levels of skills and the potential
problems they will encounter. By seeing how the experts teaching the trainees, sometimes I can learn
more than just merely observing the procedure itself. The doctors, technicians, and nurses are kind.
When we have questions, they try their best to answer us. When we ask things that are not in the routine
training, such as observing ERCP, observing colorectal surgery after conversion from ESD, joining the
ward round, having conversation about their training system and workload, and so on, they are usually
open minded and willing to satisfy our curiosity. After returning to my place, I’m surprised that
there’s even a questionnaire for international fellows to help them improving the program. If someone
ask my opinion on which hospital to visit if he or she wants to observe ESD in Japan, I will definitely
recommend NTT Medical Center Tokyo.

I am Dr. Rizza J. Umali, a General Internist from the Philippines and aspiring to become a
Gastroenterologist and Endoscopist. I applied for the program to gain exposure and knowledge with basic
endoscopic techniques as well as diagnostic and therapeutic endoscopy especially ESD in Japan. It was an
honor and privilege to observe and train under the supervision of Dr. Ken Ohata and his exceptional team
of Gastroenterologist and Endoscopist. I was mentored by Dr. Nao Takeuchi, Dr Rindo Ishii and Dr. Yohei
Minato. For the past 3 months of my stay in NTT MCT from August to November 2022, I was exposed to
different ESD cases from upper to lower gastrointestinal lesions. The unparalleled level of skill and
continuous innovation of their technique has brought me awe and amazement. ESD itself is truly hard but
the approach and individualized plan which is very unique in every case is much harder and complex. I am
also very impressed with their Screening program, the meticulous and adept screening method that even
the smallest lesion that could be missed has paved the way to decrease GI cancer in their country.
Furthermore, I have the opportunity to attend lecture series about Esophageal, Pharyngeal and Gastric
ESDs, Resection of Colorectal Polyps, Cold Snare Polypectomy, Scoring Method for SNADET, Traction method
and most of all which have gained impact is the Scope Manipulation and technique under the supervision
of Dr. Ryoju Negishi. Hands-on practical training on porcine models as well as scope insertion in
phantom model gave us a surreal experience, simulating it like to a real patient. I was also given the
opportunity to attend the annual Japan Digestive Disease Week 2022 in Fukuoka, Japan where I learned
different gastrointestinal researches and developments in Japan. Lastly, apart from the training itself,
I gained mentors at the same time friends. I was able to appreciate the diverse and rich Japan culture,
the food and drinks and lastly how accommodating and kind Japanese people were. Training at NTT Medical
Center Tokyo has given me different perspective in life and completely changed me into something better,
as a doctor and as a person. I will forever be grateful to everyone, to the whole Gastrointestinal
Endoscopy department, Dr. Ken Ohata, all doctors and consultants, endoscopic engineers, nurses and staff
for the generous help and support during my stay in the hospital. More power to TEAM OHATA!

It was an honour to be allowed the opportunity to observe, learn and participate in the Gastroenterology
Program at NTT Hospital in Tokyo, Japan.

I was an Endoscopy Fellow from Auckland, New Zealand, practicing independent endoscopy but very keen to
learn advanced diagnostic and therapeutic Endoscopy.

The goals of my 4 months at NTT were to improve my luminal endoscopy, in particular in-vivo endoscopic
diagnosis and resection of lesions with ESD. I was fortunate to work under the guidance of Dr. Ken Ohata
and his excellent team.

Here I was exposed to many new techniques, ideas and a passion for teaching endoscopy that in my
experience is unmatched. They created an incredibly supportive environment, with amazing patience to
explain, demonstrate and then supervise me in performing all aspects of endoscopy. There were additional
teaching sessions on basic science, endoscope handling and technique, improving aspects of basic
endoscopy such as colonoscopy insertion, tips to application of abdominal pressure, use of animal
models, and diagnostic pre-ESD examinations using magnification, virtual and dye chromoendoscopy and
then mucosal resection, including EMR-L, EMR-C and ESD. There is routine and regular teaching sessions
with histology and clinical correlation which further enhances understanding. Since this time, I have
returned to New Zealand and have been able to successfully adapt their tricks, tips, ideas, techniques
and concepts to improve my practice, including ESD.

In addition, they showed me through their action and observation how to improve as a teacher myself. At
their institution, teaching is seen as an expectation and taken very seriously. There was a constant and
unwavering pursuit of excellence, and I was inspired by their dedication to this craft, astonishing
attention to detail, understanding, knowledge and then finally execution of complex procedures.

I am exceptionally grateful to everyone on the team, including my supervisors, Dr. Ohata and Dr.
Muramoto and my mentors, Dr. Minato and Dr. Konishi who were always friendly and supportive. I
thoroughly enjoyed my time there, and got to know all of the team and other trainees, with Japanese
hospitality and teachings of culture and of course delicious Japanese food. Furthermore, we all managed
to improve our English and Japanese and intend to keep in touch, with collaborations to come in the
future.

It is without hesitation that I say my time in this Endoscopy Unit with Dr. Ohata and his team was the
greatest learning experience of my career so far, and I would highly recommend it to anyone interested
in learning more about Endoscopy.

Introduction of myself
I work as an associate consultant surgeon, specializing in colorectal surgery, in Princess Margaret
Hospital in Hong Kong. Apart from surgeries, I also have special interest in therapeutic endoscopy, as I
believe that early diagnosis and treatment of mucosal lesions is also an important part in the
management of colorectal malignancy.

Why do I want to learn ESD in NTT?
Since the introduction of colorectal cancer screening program in Hong Kong, many dysplastic and early
malignant colonic lesions are now detected by colonoscopy. Treatment of these lesions by endoscopic
mucosal resection is suboptimal due to piecemeal resection and positive margins. Endoscopic submucosal
dissection (ESD) emerges as an essential yet advanced endoscopic technique for these lesions. Dr. Ken
Ohata is a world-renowned expert in ESD. I am deeply inspired by his books including “大圃流“ and “ The
Text ESD” which illustrated step-by-step the strategies of ESD. By grasping these fundamental concepts,
ESD appears more “user-friendly”, efficient and precise. In fact, Dr. Ohata and his team had managed the
highest number of ESD cases in recent years in Japan.

My experience in NTT
I am very happy to obtain a 4-week clinical observership in NTT Medical Centre Tokyo in July 2019. When
I received the reply from Dr. Ohata, it was like a fan’s dream come true! Dr. Ohata demonstrated his
techniques to me and other fellows like in a masterclass, which indeed was so mind-blowing and amazing
as in a magic show. He was passionate in sharing his principles, skills and experience with us. Like Dr.
Ohata, the senior members were all very willing to teach and offer supervision to trainees. They were
very helpful and always explained to us about the procedures. I was impressed by their dedication to
achieve the best performance outcomes and patients’ satisfaction. Team spirit and working atmosphere was
good like in a big family. On one busy day, even though the last procedure finished late, all staff
members gathered around and provided peer support until the end of the procedure. ESD cases were very
diverse, ranging from upper gastrointestinal tract to lower gastrointestinal tract, extending to other
technically demanding areas like in the duodenum and pharynx. I am very grateful that they organized a
hands-on training session on porcine model for me. Dr. Minato was my tutor and it was an invaluable
opportunity to try on and practice under his guidance. I also felt delighted to have hotpot and Japanese
dinner gatherings with their residents where we exchanged not only on the medical knowledge but also our
interesting cultural differences. Last but not least, I am truly thankful to Dr. Muramoto for his
coordination in my attachment all along.
Having these exposures in NTT Endoscopy Unit, I gained more confidence in establishing the new ESD
service in my own center. I have performed 10 cases so far. I am proud to be one of the many
international followers of Dr. Ohata. I look forward to visiting again in the future to continue my
learning and to meet my friends here in NTT.

Introduction of yourself
My name is Xiquan Ke. I am an attending GI doctor and associate Professor from Anhui Province, China. I
went to study in Johns Hopkins University as a joint PhD candidate of gastroenterology in 2014, and got
a MD degree in 2016. I am very interested in diagnosis and treatment for early GI cancer.
Motivation for coming to NTT Medical Center Tokyo (NTT MCT)
From international and Chinese conferences of endoscopic performance, I know that Dr. Ohata is a very
reputable and charmful endoscopic expert, whose skillful operation of endoscope seems like floating
clouds and flowing water and like the endoscope is an integral part of his body, so he has a laudatory
title of “God Hand”.
I am one of lots of loyal fans of him in the world, worship him very much. Secondly, his masterpiece of
“Operative skill of ESD” is very popular in China, which not only can be used as a standard textbook for
beginners, but also can provide reference for experienced ESD doctors. The book is very beneficail to
deepen the understanding of ESD, shorten the learning curve and improve medical safety.
At last I find that Dr. Ohata’s team specializes in diagnosis and treatment of early-stage
gastrointestinal(GI) cancer, which is very significant for the study of endoscopy and gastrointestinal
carcinoma and fits my background very well. I was very interested in his proficient operational skills
and advanced conception of digestive endoscope technique, I also hope to improve skills in advanced
endoscopy and to learn the early GI knowledge systematically in Japan.
After I had learned that Dr. Ohata and NTT Medical Center Tokyo can provide an opportunity to study ESD
for visiting doctor and visiting scholar, so I wrote to the apply the position immediately. Thanks for
the help of Dr. Muramoto and Kimoto from Ohata’s team in my visa application and preparation.

Impression of NTT Medical Center Tokyo
There are the cases for ESD treatment of early colon cancer in NTT Medical Center Tokyo which rank
Number 1 in Japan and in Asia, the visiting doctors of digestive endoscopy center in NTT Medical Center
Tokyo are attracted by the excellent ESD technology of Dr. Ohata, who are from Japan, China, Britain,
Hong Kong, Taiwan, Israel, Italy, Switzerland, Vietnam, Malaysia, Russia, New Zealand and other
countries all over the world.
Everyone come from all corners of the world to gather together for a common goal to improve the
diagnosis and treatment of early GI cancer and ESD operation. Therefore, we can communicate happily, I
am able to understand the medical education background and medical development status of early GI cancer
in different countries.
There is discussion of difficult cases of early GI cancer on at 6-7AM on very Wednesday morning, the
resident doctor reported on diagnosis and treatment for different types of early gastrointestinal
cancer, early colon cancer, gastric cancer ,esophageal cancer, etc. There is the latest progress of
endoscopy and digestive diseases at 7-8AM.
During the academic report, the report process may be interrupted at any time by senior doctors such as
Ohata, the discussion of break the casserole and ask the end is very interesting and meaningful.
Preparations of ESD and other operations for early GI cancer is started At 8:15AM.
There are lectures for GI cancer one time every 1-2weeks and hand-on ESD traning in animal model one
time every 3-4weeks for the short-term visiting doctors less than three months, so we can learn the
NBI-ME, EUS, FNA, DBE for UGIB, ERCP, EVL and ETI for EGV, ERCP, EPMR, EFR and ESD techniques
systematically and comprehensively with the guidance of teachers from Dr. Ohata’s team in the endoscopic
center.
There will be an opportunity to do ESD for clinical patients for visiting doctors more than three months
if your endoscopic technique has been evaluated and passed by the team, I’m lucky to be one of them, I
started to do ESD in clinical cases when I got the temporary Japanese doctor’s license.
Dr. Ohata is my supervisor and the director of endoscopic center, he is very nice and friendly, who
teaches me to determine the individualized ESD treatment according to the gravity direction of lesions
for early GI cancer patients hand by hand, is different from some experts need auxiliary traction by
dental string, which can reduce the operation time. He teaches me demonstration of different endoscopic
devices in detail, such as Dual Knife and Nano IT.
He teaches me lots of tips of ESD, for example, I have learnt to enter endoscope and devices at the same
time using my right hand, and learnt to control up/down or left/right button and enter devices at the
same time using my left hand by make “Loop” to endoscope, by which I can control the endoscope perfectly
and cut the lesions freewheelingly.
There is one thing that impressed me most, it took Director Ohata four hours to do ESD for a Juvenile
polyposis patients, the size of the largest LST-G-H lesion I had seen is 155×145 mm, he dissected and
cut the nearly circumferential lesions carefully and patiently by making two tunnels, the perfect and
successful ESD operation has won everyone’s admiration. His enthusiasm for endoscopy and his pursuit of
perfection for ESD technique are always worth learning.
Furthermore, I have made great progress in ESD operation with the guidance and help of Dr. Muramoto, Dr.
Chiba, Dr. Ito and Dr. Kanda. Dr. Muramoto and Dr. Minato of Dr. Ohata’s team are engaged in ESD
treatment for early duodenal cancer and early hypopharyngeal cancer. The two docotors have the top two
ESD operations for early duodenal cancer in Japan. They are skilled, and friendly to visiting doctors.
Future plan
Before leaving, I introduced the clinical situation and scientific research of early GI cancer in our
hospital to Dr. Ohata, and sincerely invited him to our hospital for guidance. He appreciated the
achievements of our department and expressed his willingness to teach and guide in China. For the future
development and cooperation, I hope to keep close contact with Dr. Ohata’s GI endoscopic team and
gastroenterology department of NTT Medical Center Tokyo through Email, pay attention to its academic
trends, and actively participate in the international events of early gastrointestinal cancer; Also hope
that the screening, accurate examination and endoscopic ESD treatment technology of early
gastrointestinal cancer in my hospital will be enhanced through the excellent platform of NTT Medical
Center Tokyo.
Conclusion
Time has been fleeting in the past eight months. My trip to Tokyo, Japan, has brought me fruitful
results, broadened my horizons, enriched my experience, and improved my basic research and endoscopic
practice level of early gastrointestinal cancer, which is an unforgettable and forever memorable
experience for me. Thank for help of Dr. Ohata, Dr. Muramoto, Dr. Chiba, Dr. Tsuji, Dr. Minato, Dr. Ito,
Dr. Sagai, Dr. Konishi, Dr. Kimoto, Dr. Ishii, Dr. Kanda and all the other teachers from Dr. Ohata’s
endoscopic team. I look forward to meeting you again soon.