Going above and beyond (or below) the call of duty for medical research

I’ve heard of physicians using themselves as guinea pigs for their own research before, but this is ridiculous.

Yesterday, my copy of General Surgery News arrived at my office. As I was whiffling through it to see if there were any articles worth reading, I came across a tale of a Japanese doctor who was truly dedicated to his research, so much so that that I had to hand it to him. Well, sort of.

Yes, on p. 22 of the June issue of General Surgery News (sadly, not yet online as of this writing, so you’ll have to take my word for this–or check up on me in a couple of weeks when they’ll probably post this online), I found an article entitled Where Intrepid Endoscopists Boldly Go: Self-Endoscopy.

You heard me right: Self-endoscopy, in this case, self-colonoscopy (I’m not so sure that self-esophagogastroduodenoscopy is even possible.)

I’ve heard of dedicated GI docs or surgeons before, but this puts them all to shame. Steve Frandzel, the writer of the article, at least had a sense of humor about it:

One might initially surmise, a bit flippantly perhaps, that an endoscopist who performs a colonoscopy on himself has a little too much time on his hands. But a Japanese physician had a commendible goal when he inserted a colonoscope into his own colon–multiple times.

Akira Horiuchi, MD, from the Department of Gastroenterology at Showa Inan General Hospital, Komagane, Japan, discovered that a pediatric endoscope was particularly useful in patients for whom colonoscopy was difficult. He hypothesized that such an endoscope “might enable an endoscopist to perform self-colonoscopy screening, which could be a valuable research tool” to repeatedly study the effects of drugs or other therapies.

Dr. Horiuchi was even kind enough to write up his work and publish it in Gastrointestinal Endoscopy in January, where he described his technique:

After bowel preparation, the endoscopist (A.H.) sat on the back of a chair in front of the monitor. The endoscopist, who was directly facing the monitor, then self inserted the colonoscope into the colon (Figure 1). The knob of the colonoscope was manipulated with the endoscopist’s left hand, and the insertion tube was held with the right hand.

He even provided a helpful illustration of his technique:

i-36a7c5bd9b0f406d379bf863f4e0438e-Selfendoscopy.jpg

My first thought upon seeing that picture was: How on earth did he manage to do a colonoscopy on himself with his pants on? Did he have a handy hole in his pants? Best not to think too much about it.

Dr. Horiuchi’s experiment, thankfully for intrepid colorectal investigators everywhere, was a success:

In our first attempt, complete colonoscopic examination to the cecum was completed within 4 minutes, with only mild discomfort related to looping of the sigmoid colon. Because this initial attempt was so easy, it was repeated 3 additional times over the following 2 months, with cecal intubation times of 5, 3.5, and 4 minutes.

Such dedication! And, intrepid investigator that he is, he reports more:

Surprisingly, the endoscopist learned that the feasibility and the discomfort were different in each session, despite the same examiner and the same patient. This finding supports our view that patient discomfort during endoscopy may vary within the same patient.

And, finally, like all good researchers, he suggests areas for “further research”:

The fact that colonoscopy was surprisingly easy with the patient in the sitting position suggests that studies to compare sitting vs. supine positions with different endoscopes are warranted. To be feasible, colonoscopy in the sitting position would likely require the use of a specially designed colonoscopy chair.

You know, I need more publications just as bad as the next academic surgeon, but there are some things even I wouldn’t do to get another notch on my CV. His fellow gastroenterologists are even giving him the thumbs up (so to speak). Dr. Tarun Mullick, MD, at the Rush-Copley Medical Center in Chicago said this of Dr. Horiuchi, “He deserves some extra credit.”

Now that‘s an understatement! Dr. Horiuchi is subjecting himself to a very uncomfortable procedure which, while in general is pretty safe, still carries a small risk of perforating the colon each time that he does it when he doesn’t need the procedure, all in the name of science? And he’s not just doing it once, but several times, with all the bowel preps that go with the procedure. I asked EneMan what he, caped defender of colon health that he is, thought of the whole thing:

i-fdc4fdb4ab173da6d30e99885d483658-16371061_efa3ca4e2b_o.jpg

Yes, that was my initial reaction too, although I’m betting that the performer of this song would beg to differ with EneMan and would give Dr. Horiuchi a big thumbs up, as well.

Either that, or a finger wave.