ENDOSCOPIC PRACTICE IN ASIAN COUNTRIES BASED ON EXPERIENCES FROM HELICOBACTER PYLORI EPIDEMIOLOGICAL RESEARCH

Abstract

Since 2010, I have visited 13 developing Asian countries for endoscopic surveys. I present my experiences in these countries and outline the projects for eradicating gastric cancer related death in Bhutan. In these countries, access to endoscopy is limited to large cities, and there is no significant difference between the incidence and mortality rates of gastric cancer; therefore, gastric cancer is still considered incurable. The role of Helicobacter pylori is poorly understood, including among physicians, and the concept of early-stage gastric cancer is not widely accepted. In most countries, people have never seen early gastric cancer. In contrast, most gastric cancers are detected at an early stage and treated endoscopically and all patients with H. pylori-infected gastritis have access to endoscopic examination followed by H. pylori eradication therapy in Japan. This Japanese model should be introduced to the rest of the world because of the gradual decline in gastric cancer mortality rate it has produced in Japan. We have established a system to rapidly diagnose H. pylori infection and antimicrobial resistance in Bhutan, a country with a population of only 800,000, and launched a gastric cancer eradication project in collaboration with the government of Bhutan. The first step is to train endoscopists. There is an urgent need to train endoscopists, and we are always willing to send endoscopists to Bhutan to provide endoscopic skills; therefore, you may contact us if you are interested.