There is a traditional medicine that is Kampo, a kind of Chinese medicine, in Japan. Kampo medicine has been covered with Japanese health insurance since 1965 though it had been abolished in 1895. Recently, complementary and alternative medicine (CAM) imported from other countries, such as the chiropractic and the aromatherapy and so on, spreads out in Japan. The establishment of the academic meeting about CAM other than Kampo medicine is increasing. The institutions to bring it up though it is a small number as for CAM other than for Kampo medicine that is popularized widely on the education come out. However, there are few hospitals less than family doctors in terms of the practice of CAM. As a matter of fact, it is Japanese health insurance system to obstruct practicing integrative medicine in Japan. Kampo and part of acupuncture, moxibustion, Judo-seifuku like osteopathy and massage are covered with Japanese health insurance, but the others in CAM are not. After all, it is difficult to practice integrative medicine because Japanese law doesn't permit practicing CAM and western medicine at the same time under the health insurance system. The first practical institution of integrative medicine in Japanese university was established by Tokyo Women's Medical University in June, 2003. Patients can receive in the same day CAM at the Aoyama Institute of Women's and Natural Medicine and western medicine at Aoyama Hospital located on upper floor in the same building which is another institution attached with Tokyo Women's Medical University. The number of patients that visited our institution from June in 2003 to March in 2004 is 550 (Female: 171 men and 379 women), and an age was from 0 to 85 years old. We have a lot of patients suffering from cancer (80 men and 97 women). We also have patients who have a mental problem (18 men and 59 women) and patients of the incurable diseases by western medicine. CAM such as Kampo, acupuncture, moxibustion, Qigong, homeopathy, flower essence, aromatherapy, bodywork, minus ion treatment, phototherapy and the hyperthermia is performed with 2 doctors and a nurse who is bodyworker too. In the future, not only we will practice it but also research and education will be done, too.

Background/Aims: Hybrid endoscopic submucosal dissection (ESD), in which an incision is made around a lesion and snaring is performed after submucosal dissection, has some advantages in colorectal surgery, including shorter procedure time and preventing perforation. However, its value for rescue resection in difficult colorectal ESD cases remains unclear. This study evaluated the utility of rescue hybrid ESD (RH-ESD). Methods: We divided 364 colorectal ESD procedures into the conventional ESD group (C-ESD, n=260), scheduled hybrid ESD group (SH-ESD, n=69), and RH-ESD group (n=35) and compared their clinical outcomes. Results: Resection time was significantly shorter in the following order: RH-ESD (149 [90–197] minutes) >C-ESD (90 [60–140] minutes) >SH-ESD (52 [29–80] minutes). The en bloc resection rate increased significantly in the following order: RH-ESD (48.6%), SH-ESD (78.3%), and C-ESD (97.7%). An analysis of factors related to piecemeal resection of RH-ESD revealed that the submucosal dissection rate was significantly lower in the piecemeal resection group (25% [20%–30%]) than in the en bloc resection group (40% [20%–60%]). Conclusions RH-ESD was ineffective in terms of curative resection because of the low en bloc resection rate, but was useful for avoiding surgery.