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When designing an effective risk management strategy for the use of esophagogastroduodenoscopy in mass screenings, one of the things we have to consider is the medical competence level which health professionals are legally required to maintain. In order to better understand this medical competence level, we analyzed, from the risk management viewpoint, 6 judicial precedents in Japan's civil court cases where the plaintiffs suffered from accidental symptoms or complications related to screenings conducted by means of esophagogastroduodenoscopy. In three cases, shock occurred after the administration of an anesthetic or premedication drug; in two cases, massive hemorrhage occurred after biopsy; in one case, a traffic accident was induced by the effect of the administered sedative. By looking into these medical cases which later evolved into actual legal disputes, it is important to clarify how an institution providing medical care must proceed in order not to allow any other similar cases from occurring, and to offer patients safe and satisfactory medical services in general, as well as safe and satisfactory mass screenings by means of endoscopy in particular.

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The public’s attitude toward endoscopy was investigated using questionnaires and 538 subjects who underwent upper GI cancer screening at our institute. These subjects were divided into two groups according to the screening methods: Group A (93 subjects who had endoscopy) and Group B (445 subjects who had digital X-ray). According to the results of questionnaires, in Group A, the subjects underwent endoscopy, expecting high diagnostic accuracy, upon the doctor’s recommendation, or for problems with barium. In Group B, the subjects considered endoscopy unnecessary, or experienced discomfort at the previous endoscopy. Awareness of transnasal EGD in Groups A and B was 24% and 15%, respectively. The main source of knowledge about transnasal EGD was the mass media. The degree of expectation regarding the success of transnasal EGD in Groups A and B was 66% and 52%, respectively, when some information was given by our institute. Information on transnasal EGD may easily raise the selection rate for endoscopy at upper GI cancer screenings. However, information should be given properly, by explaining in a balanced way the merits and demerits of transnasal EGD, such as the good tolerability, the diagnostic limitations of ultrathin endoscopes and the possible complications due to transnasal insertion.

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A new radiographic method for gastric cancer mass surveys was evaluated by analyzing radiographic images obtained by this method, and the diagnostic accuracy was compared with that of the conventional method. The new method is the one described in the guideline. Regarding the gastric cancer mass surveys conducted in Kurume city from 1997 through 2004, the new method was compared with the conventional one in terms of the gastric cancer detection rate, the quality of radiographic images and the diagnostic accuracy. An improvement of the positive prediction rate and the rate of screening of abnormalities was noted with the new method. A significant correlation was found between the radiographic appearance and the diagnostic accuracy. In particular, the accuracy was higher for early-stage carcinoma cases. In addition, the new method was quite effective in locating lesions and in suggesting the need for further scanning. Thus, the new method is superior to the conventional method in terms of radiographic imaging and diagnostic accuracy. Further improvement and wider utilization of the new method is highly expected.

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Eating habits and a lifestyle involving smoking or lack of exercise are thought to contribute to the incidence of colon cancer, but the mechanisms underlying the contribution of these factors to remain largely unclear. We therefore examined the relationship between the colon cancer precursor adenoma and eating habits (paying attention to serum lipids, glucose tolerance, and alcohol consumption) as well as lifestyle (specifically smoking, lack of exercise, and stress). 450 subjects at Nihon University Health Examination Center underwent colonoscopy after testing positive to the fecal occult blood test. Subjects were divided into two groups: those with and without polyps. Serum lipid, HbA1c, and IRI concentrations were measured. Colon adenomas were categorized by size into three groups: small (<5mm), middle (5-10mm), and large (>10mm). In addition, the following environmental factors were examined: alcohol consumption, smoking, exercise, and stress. Serum cholesterol and IRI concentrations were high and correlated with adenoma size. No correlation was found between adenoma size and alcohol consumption, smoking or exercise. However, adenoma size was significantly larger in the stressed group in comparison with the unstressed group. From the observation that colon adenoma incidence is related to the eating habit-dependent factors hypercholesterolemia and glucose tolerance levels, and to lifestyle-dependent stress levels, it is advisable to consider these high risk factors during medical examinations.

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From 2002 to 2005, we performed mass surveys using abdominal ultrasonography for a total of 91,803 people at our institution. We reviewed our database and obtained the following data : 1) the percentage of cases where re-examination was recommended, 2) the percentage of cases where thorough examination was recommended, 3) the percentage of the cases where follow-up examinations were conducted, and 4) the detection rate for malignant diseases. The percentage of re-examinations recommended and the percentage of thorough examinations recommended were found to be 1.9% and 1.6% of the total, respectively. The percentage of cases where secondary re-examinations or thorough examinations were carried out was 21% and 27.7%, respectively. Malignant diseases were detected in 20 patients (0.022%), including 2 hepatocellular carcinomas, 5 metastatic liver cancers (with the colon as the primary organ in 3 cases, the pancreas in 1 case and the breast in 1 case), 1 hilar cholangiocarcinoma, 2 pancreatic cancers, 9 kidney cancers and 1 urinary bladder cancer. The detection rate at our institution was lower than that previously reported by other institutions (0.07～0.135%). One reason could be that we did not always obtain whole sets of information on the results of follow-up examinations once referrals were made. Thus, we believe that a post-survey management system must be established from the quality-of-care viewpoint.

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[in Japanese]

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[in Japanese]

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