The screening performance of transnasal and standard transoral esophagogastroduodenoscopies (EGDs) was compared by analyzing the detection rates of gastric mucosal neoplasias (adenoma and cancer) by each endoscopy based on the pathological conditions of the background gastric mucosa, especially according to the stages of the progression of H.pylori-related chronic gastritis. The transnasal EGD group included 1,280 subjects and the detection rate of gastric mucosal neoplasias was 1.64% (21/1,280), while the standard EGD group included 1,707 subjects and the detection rate of 1.87% (32/1,707), indicating no significant difference between the two groups. Likewise, the detection rate of the two endoscopies was in a comparable level regardless of H.pylori infection. However, the detection rate by standard EGD (0.79%) was significantly higher in the screening of a group of subjects without gastric atrophy than that by the transnasal EGD group (0.13%) (P<0.05). Especially, the standard EGD was significantly better in the detection of neoplasias in subjects with H.pylori-related non-atrophic gastritis; the detection rate in the standard EGD group (3.11%) was significantly higher than that in the transnasal EGD group (0.53%) (P<0.05). These results indicate that the diagnostic performance of a transnasal endoscope is suboptimal in the cancer screening, especially in a group of subjects with H.pylori-related non-atrophic gastritis.

View full abstract

We compared the clinicopathological findings of 310 early gastric cancer cases detected by peroral endoscopy with 72 cases detected by transnasal endoscopy at Kawasaki Medical School and other cooperating hospitals.
We focused on whether there were any differences in the following:(1) Macroscopic types,(2) Size, (3) Three portions of the stomach, (4) Four equal parts of the gastric circumference, (5) Depth of tumor invasion,(6) Histological typing, (7) Stage grouping, (8) Ulcerative findings, and (9) Guideline criteria for endoscopic resection.
Regarding the macroscopic types, IIc lesions accounted for 63.2% by peroral endoscopy and accounted for 61.1% by nasal endoscopy. The mean size was 20.6mm by peroral endoscopy and 19.7mm by nasal endoscopy. The ratio of lesions 10mm or less accounted for 28.4% by peroral endoscopy and 37.5% by nasal endoscopy. The ratio of guideline criteria for lesions in endoscopic resection was 44.2% by peroral endoscopy and 45.8% by nasal endoscopy. We also added the same examination for lesions of 10mm or less. Because there were no significant differences found in both examinations, it is considered that transnasal endoscopy should be recommended for the screening of gastric cancer.

View full abstract

We studied the usefulness of CT colonography (CTC) for colon cancer diagnosis. CTC and optical colonoscopy were performed for 150 cases mainly including patients with a positive fecal occult blood test (FOBT). The results were compared and analyzed. The following are the final diagnoses given to the patients: advanced colon cancer: 41 cases; early cancer: 25 cases; adenoma: 74 cases; hyperplasia: 3 cases; submucosal tumor: 1 case; and no lesion: 6 cases. In terms of diagnostic performance of CTC, accuracy was found to be 96%, sensitivity was found to be 97.9%, and specificity was found to be 50%. Cancer stage-specific sensitivity was as follows: advanced colon cancer: 100%; early cancer: 96.3%; adenoma: 71.2%; and hyperplasia: 47.4%. Lesion site-specific sensitivity was as follows: caecum: 76.2%; ascending colon: 57.6%; transverse colon: 66.2%; descending colon: 83.3%; sigmoid colon: 85.1%; and rectum: 78.0%. Lesion size-specific sensitivity was as follows: 2 to 5 mm: 56.7%; 6 to 9 mm: 88.1%; 10 mm or more: 92.5%; and 6 mm or more: 90.9%. Therefore, the diagnostic sensitivity of CTC was confirmed to be high. The results suggest that CTC would be useful for colon cancer screening.

View full abstract

We examined colorectal cancer screening using fecal occult blood tests from fiscal year 2005 to 2009 at our facility in Ishikawa prefecture. The complete examination rate in each fiscal year was 79.8, 82.5, 85.7, 83.4, and 78.7% in the order of the time series. All of them were higher than the national average by about as much as 10%, and those of fiscal year 2007 and 2008 were higher than that of others. The cancer detection rate in each fiscal year was 0.16, 0.17, 0.26, 0.26, and 0.22% in the order of the time series, and those of fiscal year 2007 and 2008 were higher than that of others. In our facility, client reminders have been performed up to two times, which may contribute to the high complete examination rate.

View full abstract