ブータン王国における内視鏡診療の経験

Abstract

京都大学医学部附属病院の国際支援事業によりブータン王国にて内視鏡診療に従事する機会を得た。ブータンでは消化器内視鏡検査は国内唯一の消化器内科医師と外科医師により行われており, 治療困難な症例は国外へ搬送されていた。内視鏡的逆行性膵胆管造影 (Endoscopic Retrograde Chorangiopancreatography: ERCP) 目的の国外搬送も絶えないため, ERCP 導入を中心とした内視鏡診療支援を行うこととなった。10週間の滞在中に約900件の内視鏡を施行した。大部分は上部消化管内視鏡検査であったが, ERCP に関しても, 現地の医師, 看護師を指導しながら, 23件を施行した。ブータンの内視鏡診療の現況に加え, ブータン人における消化器疾患の頻度及び ERCP 導入の実際について報告する。

We provided medical care in the Kingdom of Bhutan from January to March in 2014 through the international medical support program of Kyoto University Hospital. Bhutan is a small, developing country with a population of about 700, 000 citizens located at the southern foot of the Himalayas. There are only 244 medical doctors in Bhutan (one-tenth of the number of doctors relative to population in Japan). Because of the shortage of doctors and the limited medical resources, patients with difficult-to-treat conditions are transferred to India or other countries. Gastrointestinal endoscopy is performed by the country's only gastroenterologist and six surgeons, mainly in Jigme Dorji Wangchuk National Referral Hospital (JDWNRH) at Thimphu. Several years before, a Bhutanese surgeon had learned to perform endoscopic retrograde cholangiopancreatography (ERCP) in Thailand. However, ERCP cannot be established in Bhutanese routine clinical practice because of its technical difficulty. Although a duodenoscope and some devices for ERCP are available, at least one patient who needs ERCP is transferred to India every month. In this context, I was asked to reintroduce ERCP into JDWNRH. ERCP was performed in 23 cases involving 17 patients with the cooperation of Bhutanese doctors, nurses, and technicians. My experience leads me to believe that we can build a platform to continue ERCP in JDWNRH. During the 10 weeks, I also helped to perform about 900 endoscopies, mainly esophagogastroduodenoscopy, and I taught endoscopic techniques and diagnostic approaches to Bhutanese doctors. In this report, I describe the current status of endoscopy in Bhutan including the incidence of Bhutanese gastrointestinal disorders and the experience specifically related to introducing ERCP.