[in Japanese]

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[in Japanese]

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[in Japanese]

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A survey of transnasal EGD was conducted in the form of a questionnaire given to 14 medical institutes that made presentations at Workshop 24 “Present status and problems of upper GI screening with transnasal EGD” at the 2007 conference of JDDW in Kobe. The selection rate with and the number of examinations using transnasal EGD varied considerably among individual patients. Transnasal or transoral EGD was usually selected, according to the patient’s preference, but the issue should be discussed further in private clinics which employ ultrathin scopes only. Regarding the contents of the informed consent, the following points were frequently discussed with the patients: comfortable examination with less frequent induction of the gagging reflex, the possibility of nasal pain or epistaxis, and the possibility of insertion via the oral route if the nasal cavity is too narrow. On the other hand, the possibility of poor maneuverability during target biopsy was explained in a few cases. The methods of nasal anesthesia also varied among the individual patients. Efforts were made to reduce the total amount of anesthetic agent in some cases. As for the complications, the rate of epistaxis was almost completely compatible with the previous reports. However, careful attention should be paid to those few cases in which there are difficulties in withdrawing the scope or sinusitis-like symptoms appear the day after the examination. Further scientific investigation of transnasal EGD will be indispensable in the future, including follow-up studies of false-negative cases.

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[BACKGROUND] The association between the body mass index (BMI) and the occurrence of colorectal adenomatous polyps (polyps) has been reported to differ between men and women. However, no compelling scientific basis for the relationship between obesity and the development of polyps among Japanese people has been put forth to date. We compared the prevalence of polyps in men and women, and examined the role of the patient's BMI in the risk of developing polyps according to age and gender.
[SUBJECTS AND METHODS] The risk of developing polyps was studied in 15,410 subjects (7,173 men and 8,237 women) who underwent colonoscopy for the first time from April 1992 to April 2006 at our “Human Dry Dock.” The eligible subjects were 20 - 86 years old (mean age ± SD, 47.6 ± 8.6) and free of invasive cancer, hyperplasic polyps and familial polyposis. Adenoma was found in 1,604 subjects (1,069 men and 535 women). The odds ratio (OR) of polyp detection in relation to obesity was determined in all cases by multivariate logistic regression analysis after adjusting for gender and age. In addition, body weight reduction was studied on 952 obese subjects who had no polyps at the first colonoscopy and underwent a second colonoscopy the following year. The prevention factor for the occurrence of polyps was examined based on the weight decrease over the one-year period.
[RESULTS] The OR of polyp detection in obese subjects (BMI >= 25) versus non-obese subjects (BMI < 25, OR = 1) was 1.33 (p < 0.001) in men and 1.08 (p = 0.55) in women. As the BMI increased in increments of one, and the OR for men in the present study increased significantly to 1.01 (p < 0.001), whereas the OR for men in the past study (ten years before) remained unchanged at 1.00 (p = 0.08), an insignificant result. The OR in the male weight-reduction group was 0.53 (p = 0.03) and 0.71 (p = 0.55) in the female weight-reduction group. A body-weight reduction of 0.5 % was revealed to decrease the risk for adenoma in men.
[CONCLUSIONS] We conclude that obesity in men is a risk factor for the development of polyps. Body-weight reduction was revealed to decrease the risk for developing polyps in men. These results must be confirmed by additional epidemiological studies.

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Annual as well as biennial screening for colorectal cancer has been proven effective for decreasing the mortality rate. We investigated the effect of changing the screening interval from one year to two years on tumor detection. We obtained data for invasive cancer found within two years of screening by cross-checking the regional cancer registry and prefecture-wide colorectal cancer screening of 246,660 individuals in Fukui prefecture between 1992 and 1998. Individuals diagnosed with cancer within one year of annual screening were defined as the annual group, and those diagnosed within one year of biennial screening or within one to two years of annual checkup were defined as the biennial group. The interval cancer rate and cumulative survival rate were compared between the two groups. In addition, the hazard rates for colorectal cancer mortality were compared using the Cox proportional hazards model.
The interval cancer rate in the biennial group (111 cases) was 40%, which was significantly higher than the 17% (p < 0.001) observed in the annual checkup group (90 cases). The five-year cumulative survival rate was 73.0% in the biennial group, which was significantly lower than that the 88.9% (p = 0.003) observed in the annual group. Furthermore, mortality risk was 2.3 times higher in the biennial group compared to the annual group (p = 0.043).
Therefore, it should be noted that changing the screening interval from one year to two years increases the interval cancer rate and is associated with a worse prognosis.

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