Past, present and future of gastroenterology in Japan: The 100th anniversary of the Japanese Society of Gastroenterology in 1998

The Japanese Society of Gastroenterology (JSGE) will celebrate the centenary of its foundation in 1998. A variety of plans and projects are being prepared by the JSGE centennial celebration committee. In this article, the history of the JSGE is briefly described, and several projects, including the international symposium currently being planned, are introduced. The future prospects of our Society will also be described.     

When does a guideline become a standard? The New American Society of Anesthesiologists guidelines give us a clue

So when does a guideline become a standard? The answer is when an inexpensive, reliable device comes onto the market, the technology and concept of which have already been adopted by a group who specialize in the concept of intubation—anesthesiologists. A guideline becomes a standard of care when the device behind the guideline is available and readily usable as a practical matter by members of other medical specialties who have cause and reason to consider its use.By the time a piece of technology is recognized by legislators or insurance company underwriting departments as a necessary tool in the arsenal of a group of medical professionals, essentially as a standard of care, it is too late in the sense that the damage will already have been done because the malpractice suits that motivated the legislative or underwriting change already will be inescapably present.The mandation of a standard of care by legislative or insurance underwriting fiat certainly ensures the existence of the standard and will serve to require the use of the procedures, techniques, or technology so mandated. Before the mandation by law, however, the profession must recognize the matriculation of the idea to the guideline to the standard. Waiting for adoption of the standard by law or insurance company underwriting departments gives the plaintiff's trial bar “an edge,” in that they are able to assert that a standard exists that the physicians are ignoring.From a legal point of view, a physician, EMT, or paramedic who does not use a disposable end-tidal CO₂ detector in the process of intubation, in the absence of electronic capnography, is not acting as the average reasonable reputable physician, EMT, or paramedic would under the same or similar circumstances in the same or similar location and therefore may be said to have breached his or her duty to exercise reasonable care. If the failure to use the device results in a catastrophic untoward result secondary to esophageal intubation, the physician, EMT, or paramedic may be said to be a “legal cause” or “substantial factor” in the outcome and thus responsible for the damages determined to be present.     

The role of the endoscopist in a multidisciplinary obesity center

The endoscopist plays an integral role in the multidisciplinary treatment of patients with obesity who are undergoing bariatric surgery, particularly in the prevention and treatment of postoperative complications. Although still controversial, routine preoperative EGD should be considered in all bariatric patients, especially those undergoing RYGB, regardless of the presence or absence of symptoms. Endoscopists need to work in close coordination with their bariatric surgery colleagues in all phases of care to maximize the yield and safety of endoscopy in this patient population.