Cancer Screening / Endoscopy Specialist Takahiro Fujii Clinic

Prior day to colonoscopy, full meal (Breakfast-Lunch-Dinner) of boil in the bag food (easy to digest and low digestive residual) will be provided from the clinic.: ※For those who feel hunger may have additional easy to digest food, such as udon(Japanese noodle).
Before going to bed, patients will be asked to take irritant cathartic, either 1 bottle of Laxodate (Picosulfate Sodium hydrate) or Soldana (Sennoside) provided from the clinic.: ※Laxodate must be dissolved to 200ml of water

Patients will be asked to take 3 pills of Ganaton (Itopride) to activate the intestine, and 30minutes after that cathartic drug and intestine cleaning drug (about 1500ml – 1800ml) slowly, taking more than an hour.

※Intestine cleaning drug tastes like a sports drink, and can be drank with no pain
※Sometimes patients tell us that “The colonoscopy wasn’t painful at all, but drinking the drug was quite tough”

To avoid this, we advise the best way to drink for each patient.

Home： Patient can take the intestine cleaning drug at home and come to the clinic after the intestine is clean.
Clinic： Patient can take the intestine cleaning drug at our clinic (Patients from far or elderly) The preparation is ready and able to start the colonoscopy when the color of stool turns to like the left picture.

Patients will be asked to lie sideways on the bed, and will be injected a light sedation and pain relief. Then the colonoscope will be inserted from anus up to the cecum.
Extreme skill is needed to send the colonoscope as straight as possible means folding a 1.5m large intestine, like folding an accordion. By using this technique, the patient can end the colonoscopy quickly and with no pain.

大腸内視鏡検査

The colonoscope is inserted by stretching the bend of sigmoid colon. This causes extreme pain.

大腸内視鏡検査

The sigmoid colon is straightened by the director‘s technique. This technique needs great experience, but by this technique the patient hardly feels any pain.

From the effect of sedation and some drugs used in the colonoscopy, the patient may feel some dizziness. The patients will be asked to take some rest in the recovery room for a while. Please avoid driving after colonoscopy; it is extremely dangerous.

Patients who are taking anticoagulant drugs will have some issue of bleeding when resecting polyps. They will be advised to stop medication 7days prior to the procedure. Our staff will make further explanation to those patients.
Please take other medications (Blood pressure, Cardiology, Asthma etc.) early in the morning (about 8AM), on the day of colonoscopy.

(Except, please do not take insulin shots or other diabetes drugs)
Patients can drink water or have candies or a chewing gum when they feel thirst or hunger.

To find cancers which are difficult to detect, such as small or depressed type, the intestine needs to be clean as possible. When there are stools left in the intestine, those residuals makes it even more difficult to detect, hiding like depressed type cancer

Picture1 Stools left in intestine

You may find polyp type cancer (with stalk), it is difficult to find depressed type cancer

Picture2 Clean intestine

Not only you may find polyp type cancer (with stalk), but also for depressed type cancer

In the past, the cause of colonic cancer was though that from a wart kind polyp, and the focus of colonoscopy was to find and resect the polyp as much as possible. On the other hand, depressed type tumor can quickly become cancer and has certain metastasis rate even below the size of 10mm.
As these depressed type cancer was difficult to find and easy to miss, it was said that the lesion is distinctive to Japan from the western doctors.

The director, Dr. Fujii lectured endoscopy for 4months in the UK as a co-researcher, and found 2 depressed type cancers and reported and published to international society. Now this depressed type cancer is drawing many attentions internationally.

Our clinics goal is to detect these difficult to find depressed cancer and provide accurate diagnosis and the best therapy.

First depressed cancer found in western world
Picture of first depressed cancer in UK citizen
Slight reddish mucosa change is the key to find these lesions. Lesions easy to miss.

Same lesion after stained
Using staining the depressed lesion can be detected
This lesion was completely cured after endoscopic resection

Patient was advised surgery for this 30mm large lesion at sigmoid colon. Suspect cancer in part of the lesion.

In normal hospitals, a tissue of the lesion will be taken for pathology and will be treated with endoscopic resection with a hospital stay or open surgery depending on the pathological result.

In our clinic, combining NBI and Cristal violet staining, diagnosed that it is an early stage cancer staying in the mucosa layer and was completely resected endoscopically. By closing the wound completely the patient was able to return home safely on the same day.
Pathological image of endoscopically resected lesion. Exactly as we expected from the endoscopic diagnosis, there was well-differentiated adeno carcinoma in part of the lesion but staying inside the mucosal layer. As it showed complete resection with very low risk of metastasis, we concluded complete cure of the lesion.

Our clinic offers the top level diagnosis ability with magnifying endoscope for malignancy of the polyp and defining the possibility of endoscopic resection. This also leads to completing, from diagnosis to treatment in single endoscopy procedure.

6mm depressed type tumor found at our clinic.
We pay great effort to detect depressed type tumors by using High-Vision magnifying endoscope, which often is missed. These kinds of cancers show negative with fecal occult stool test and also hard to detect with barium examination.
To detect these kinds of depressed type cancer, we need to clean the intestine and perform a high quality endoscopic examination requiring extreme skill.
[“Craftsman’s work “ Detecting Ⅱc(Depressed type)]

: 6mm depressed type tumor found at our clinic.（IIc type).
This photo was taken after detected with NBI observation.

: Normal (White light) endoscopic image of same lesion. It is extremely difficult to detect.

: Staining with indigo carmine makes clear that it is a depressed lesion

: Endoscopic image of the lesion, magnified to ×100 and stained with Cristal Violet
We defined that it is endoscopically resectable by this image, and treated immediately with endoscopy.

: Pathological image of endoscopically resected lesion. Where you can see the complete resection.