GEDF Thailand

09/12/2025

The recent visit to Khummouane District hospital, LAPD. This is the short comment from dr. Siriporn who is an active gastroenterologist of GEDF who joined us this year. “We visited Khammouane Hospital in Thakhek, Laos, from 8–9 Dec 2025. The team once again showed great hospitality. Dr. Dao's polypectomy skills had noticeably improved; we performed three colonoscopies with polypectomy. After a full day of work, we also visited Tham Pa Seuam—a striking limestone cave with a clear river flowing through it—which was both beautiful and memorable.”

22/10/2025

22/10/2025

October 20-21, 2025 ‘s trip, was one of the most productive days of our foundation trips. Five of very very difficult cases of ERCP ever ( the egg size- common bile duct stones) ! Dr. Varayu, our president and advanced endoscopist, spent a lot of time coaching dr.Sangdao ( Mahosod’ ERCP man) to complete these cases. The last case finished at 10 PM! A million thanks to all the supporting staffs esp. Mahosod young faculties ( dr.Dew and dr. Bae), our technician khun Wiroj, Mahosod’s nurses, anesthesiologist and his team, the radiologists with their bi-plane fluoroscope for this hard -and-long-working day. At the same time, two cases of EVL and 1 large gastric varices histoacryl injection , Haemorroid banding ligation, including many basic endoscopy cases were performed and supervised by dr. Pitulak. We also had MOU signment ceremony with Setthathirat hospital for three more years of endoscopy center development plan. In the bear future, all of us , will be workibg together to improve the Endoscopy services in LAPD, for the better quality of lives of the patients. See you again very soon.

10/10/2025

This Khammouane district hospital visit during Oct6-7, 2025. Apart of me and our new endoscopic nurse(khun Ann), we were thankful to Dr. Napat who is a dermatologist, who were willing to share her expertise with the medical doctors in Laos, including OPD service. After she spent the whole day, treated 52 patients, she flew back to BKK on the same day. We trained 3 doctors in this visit; one surgeon and two internists for the hands-on EGD, colonoscopy and EMR polypectomy. One case of colon cancer also diagnosed and the surgeon who joined the training will taking care of this patient in the future. We also had a chance to join the local event; Illuminated Boat Procession or Lai Ruea Fai Festival too. Such a joyful time!

22/08/2025

This is another productively visit to khammouane hospital , LAPD. Please take a look at a ‘Systematic summary’ of this visit by our colleague, Assoc. Prof Arunchai from Hatyai hospital, as tge following; ** Subject: Khammuan Provincial Hospital — endoscopy training debrief (20–21 Aug 2025)

Quick update from Khammuan Provincial Hospital, Thakhek (Lao PDR) — 20–21 Aug 2025.
Local contact: Doctor Doa.

Who we trained & what we did

Trainees: 2 physicians (1 internist, 1 surgeon)

Cases under supervision: 6 EGDs + 4 colonoscopies (no therapeutic cases)

Sedation: moderate sedation with anesthesiology support

Incidents/adverse events: none

What looked good

Small, very motivated team—quick to listen and adapt.

Enough patient volume to keep skills moving.

Solid safety mindset; they’re open to checklists and templates.

What is working well now

Documentation/photos: They complete standard endoscopy reports with adequate photo sets (EGD landmarks and cecal landmarks).

Reprocessing: The unit is doing an excellent job. We suggested small improvements—clearer labeling and accessory organization—to make the flow even smoother.

Sedation: High-quality, standard approach under anesthesiology support. Monitoring follows standards with good records and a simple, clear discharge checklist.

What needs attention (real blockers)

Equipment utilization & therapeutic skills: CO₂ insufflation and an electrosurgical unit (e.g., Erbe) are available but not used routinely. We advised and supervised on integrating these into daily practice for both patient comfort and cost-effective instrument use. Some knowledge gaps may remain. We also taught hemostasis with a coagulation grasper and hot snare polypectomy.

Supervision/exposure: Continued close supervision is recommended. Limited exposure to high-volume units shows up in scope handling, loop management, and polypectomy readiness.

Overall, the team has the right attitude and a safe baseline. With steady supervision and more deliberate use of CO₂/ESU and basic therapeutic tools, they’ll progress quickly.

--
Arunchai Chang

Associate Professor in Gastroenterology
Head of Division of Gastroenterology
Department of Internal Medicine, Hatyai Hospital, Songkhla, 90110 Thailand

25/07/2025

Summary of Advanced Endoscopy Program: GEDF x Nakhonthai Crown Prince
Challenging Cases – Real Techniques – Real Hands-On Learning from Seniors to Juniors

July 22–23, 2025

The Gastrointestinal Endoscopy Development Foundation (GEDF) collaborated with the Surgical Team of Nakhonthai Crown Prince Hospital to conduct hands-on academic training in Advanced Endoscopy, combined with practical sessions for nurses and assistants on proper endoscope reprocessing and maintenance. This training was kindly supported by Olympus Thailand, who provided on-site training for the nursing team and assistants.
One remarkable highlight: Nakhonthai Hospital prepared six challenging cases involving complex biliary and esophageal diseases that required advanced techniques and specialized equipment. This included a milestone first for Phitsanulok Province — the successful use of Cholangioscopy with Electrohydraulic Lithotripsy (EHL) combined with the SpyGlass system to fragment intra-ductal stones in a real patient, all performed in a community hospital far from tertiary care centers.
This achievement shows that with the right skills, teamwork, and commitment, it really is possible to expand access to high-level care closer to local communities.
GEDF strongly believes that enhancing the service capability of rural and district hospitals to approach the level of larger referral centers is a challenging mission — but with genuine willingness to learn and improve together, it’s absolutely achievable. This project proves once again that the Nakhonthai Surgical Team is ready to go even further.

Detailed Case Summary
ERCP – Complex Biliary Cases (4 cases)
Case 1 – CBD stone with recent NSTEMI
The patient had a common bile duct (CBD) stone with concurrent non-ST elevation myocardial infarction (NSTEMI). Due to cardiac risk, definitive stone removal could not be performed immediately.
The team performed Endoscopic Retrograde Cholangiography (ERC) with CBD stent exchange to decompress the biliary system and reduce the risk of cholangitis, with plans for definitive stone clearance once the cardiac status stabilizes.

Case 2 – Large Primary CBD Stone
A large single CBD stone 3cm in the distal duct:
Endoscopic Sphincterotomy (EST) was performed to access the stone.
SpyGlass cholangioscopy was utilized for direct visualization of stone.
Electrohydraulic Lithotripsy (EHL) was applied to further fragment the stone.
Fragments were extracted using balloon trawl and Dormia basket until the duct was clear.

Case 3 – Multiple CBD stones with right IHD & cystic duct stone (pre-LC)
The patient had multiple stones in the CBD, right intrahepatic duct (IHD), and a cystic duct stone.
Endoscopic Sphincterotomy (EST) was performed. Mechanical lithotripsy by using LithoCrushV (Olympus co.Ltd. ,JP) was performed and encounter difficulty which solved by using Sohendra lithotripter as the ‘Rescuer’. After crushing the stone into fragments,
Balloon trawl and basket extraction were used in multiple passes to clear stones from the CBD, right IHD, and cystic duct.
Clearance was confirmed by intra-procedure cholangiogram.
Definitive laparoscopic cholecystectomy (LC) will be planned subsequently to address the gallbladder and prevent recurrence.

Case 4 – CBD stone
A moderate-sized CBD stone:
EST and balloon extraction were performed.
Complete duct clearance was confirmed by fluoroscopy.

EGD – Advanced Therapeutic Endoscopy (2 cases)
Case 5 – Achalasia Type IV (long-standing, refused surgery)
The patient was diagnosed with Type IV Achalasia with sigmoid esophagus, had refused definitive surgical treatment (Heller Myotomy) and had been feeding via OG tube for over two years:
Esophagogastroduodenoscopy (EGD) with Endoscopic Balloon Dilatation was performed using a 30 mm Rigiflex (pneumatic) balloon dilation.
The Lower Esophageal Sphincter (LES) and proximal narrowing were dilated to restore adequate lumen diameter.
The patient was able to switch to soft oral feeding immediately post-procedure, discontinuing OG tube feeding.

Case 6 – Benign Esophageal Stricture (Esophageal Web)
The patient had a benign esophageal stricture (likely peptic or acid reflux):
EGD Balloon Dilatation with a CRE balloon expanded the lumen from

05/07/2025

First trip GEDF !

03/07/2025

Just returned from our trip to Khammouane District hospital, Laos.
We had a very productive trip with some new people joining us.

Ajarn Taya, a gastroenterologist from Ramathibodi hospital, came for the first time with our regular ajarn Pitulak (Samitivej hospital) to help teach endoscopy to the Laotian doctors -who varied from complete beginners to being able to do colonoscopy on their own to some extent. Dr Taya also used his varix trainer model #1 to practice scope manipulation to improve their scope handling skills. At endoscopy we found gastric ulcers and cancers in the patients who came for endoscopy over the two days.
As there is no formal gastroenterology training program the local doctors doing endoscopy said they appreciate the endoscopy teaching they get from our visits.

Dr Taya also gave a lecture on variceal bleeding to the medical and surgical doctors. (Hopefully he understood their questions correctly as his Laotian is not very good😅)

Dr. Pitulak also checked the processes in the washing room to make sure everything was up to international standard as well as discussed plans with the hospital management for the development of a full endoscopy unit. Fortunately we had Ajarn Chatchai and ajarn Kawin from the department of Architecture , Chulalongkorn University with us for the first time as well. They kindly volunteered to help advise about the design of the new endoscopy room, as they are the top experts on endoscopy suite design having written a comprehensive book on it for the Thai Association of Gastrointestinal Endoscopy (TAGE)!
Although the endoscopy unit at Khammouane is the only active endoscopy unit across 3 provinces which probably covers 1.5 millions people, the current building, although recently renovated and beautifully repainted, is 100 years old and can only be used to scope 1 patient at a time. So hopefully in the near future Khammouane will have a better functioning endoscopy unit to help cater for the general population in the area.

We would like to thank the donors who together made it possible to have this functioning endoscopy service in Khammouane . This would not be possible without the kindness and support of many people who have donated through our foundation and also those who supported independently. Not least, your support has allowed us to provide much of the necessary equipment and medications so that the doctors can use the equipment effectively and safely.
(We noted that the main endoscopy station and scopes were bought with money from Tono’s swimming campaign! (One Man and the River)!! So thank you all who donated to that campaign too!)

Lastly we would like to thank our Laotian hosts, who looked after us very well as usual. See you soon !

22/06/2025

We ‘ve just come back from one day trip at Nakhon Thai Crown Price hospital , Phitsanulok. We delivered Procedure room’ clock, Ultrasonic cleaner, ERCP & endoscopic accessories and set up the (Newly-donated) Endoscope storage cabinet. We also teamed-up with Nakhon Thai’s staffs, Olympus’s staffs and engineers to discuss intensively about the Endoscopic unit design. A thousand ‘thank you’ to ‘khun TOP’ 🙂, our talent engineer, for his remarkable helpsssss. Such a very effective jobs in this limited hours (10AM to 1PM)!!! See you guys again shortly! 🙂 😉

11/06/2025

Our visit to Vientaine, Laos this time was very very effective! The three of us ( 2 of gastroenterologists and our most beautiful endoscopic technician ’khun Ning’) share our experiences with the two medical schools in Laos. Setthathirath and Mahosot Central hospital. A lot of activities ran simultaneously, ERCP cases discussion and performing ERCP(8 cases), Histoacryl glue injection for GV( first case in Vientaine) , Percutaneus Endoscopic Gastrostomy( PEG) which is the first case in Laos. Every procedures were successfully done without major adverse events. Thanks to all of you guys ( Laos’ doctors, nurses, including Mahosot’s administrative officers) for your cooperation. Until we meet again in 3 months!

03/06/2025

Our second visit to Nakhonthai Crown Price Hospital. We spent ,2 days and one night,our time working together with the three musketeers(Endo-surgeons).🙂 performing EGD with EVL, ERCP and spent a lot of time practicing EVL and Endoscope manipulation using the models ,which are donated from Assoc. Prof. Taya(one of our team colleagues), from Ramathibodi hospital, setting up the current endoscopy and reprocessing rooms,learning about reprocessing and so-on. We also had a chance to discuss about the ‘Endoscopic Unit renovation maintenance and development plan’. 🙂 🙂 Congratulation to the patients of Nakhonthai and near-by districts that they have very attentive medical stuffs to take care of them. We will meet every 2 months then(as per our schedule). See you soon!!! 🙂