The Japanese Society of Gastroenterological Cancer Screening is celebrating its 50th anniversary this year. In this paper, we describe the prediction and prevention treatment of hepatocellular carcinoma (HCC) in present times. First, let me describe the patients with chronic hepatitis C who are included in the high-risk group for the development of HCC. When we analyzed the high-risk group for HCC development in patients with chronic hepatitis C who were treated with interferon alpha agents, it included elderly, male patients with a platelet count of less than 150,000 and an ALT value of less than 80IU/L.
Furthermore, I shall describe the prevention treatment for HCC development. IFN treatment may be considered as the primary or secondary prevention treatment of HCC resulting from chronic hepatitis C. Our facilities monitored the long-term outcome in patients who underwent IFN therapy from 1992 to 2011, prospectively. We examined the long-term outcome in these IFN treated patients by analyzing the cumulative incidence of HCC development in them. As a result, the cumulative incidence of HCC development in patients with IFN therapy is significantly low compared to that in IFN untreated patients. When I compared the incidence of HCC in patients with ALT levels between less than 80IU/L and greater than 80IU/L under IFN treatment after the IFN administration periods, the cumulative incidence of HCC development in patients with ALT levels below 80IU/L was significantly lower than that in patients with ALT levels over 80IU/L. Even in patients at stages F3 or F4, IFN administration is suggested to suppress the development of HCC in chronic hepatitis C patients compared to IFN untreated patients. In conclusion, IFN administration improves the long-term outcome in patients with chronic hepatitis C by suppressing the development of HCC resulting from chronic hepatitis C.

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The narrow-band imaging system (NBI) is based on modification of the spectral features obtained with each optical filter by narrowing the bandwidth of the spectral transmittance. An autofluorescence imaging videoendoscopy system (AFI) provides real-time pseudocolor images from the computation of detecting natural tissue fluorescence from endogenous fluorophores that are emitted by excitation light. These modalities can enhance the visualization and facilitate the detection of esophageal cancers. To investigate the diagnostic yield of NBI and AFI for screening of squamous cell carcinoma of the esophagus, we reviewed previous reports. We found seven original articles that prospectively investigated the diagnostic yield of NBI or AFI for esophageal cancers. In the per-lesion-based analysis, the sensitivity of white light imaging, AFI and NBI were 50-56%, 60% and 81-100%, respectively. In the per-patient-based analysis, the sensitivity and specificity of NBI were 88-100% and 90%, respectively. NBI has shown favorable results, and is now regarded as the standard modality for screening of esophageal cancer.

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Since 2006, a sample training course program of transnasal EGD has been performed at our department. Before viewing real endoscopic examinations, informed consent (IC) of transnasal EGD, medical interview, premedication, insertion technique, and safety management were explained, by employing an IC form, clinical pathway (both for patients and medical staff), and a power point file with moving images. For 18 doctors and 13 nurses from other medical institutes, this program was performed and a questionnaire survey was conducted to evaluate the usefulness of explanation before examination and the clinical pathway. Explanation before examination was evaluated as useful by 28 respondents, and slightly useful by 3 for understanding transnasal EGD. The clinical pathway for patients was evaluated as useful by 27 respondents, slightly useful by 2, and undetermined by 2 for patient’s explanation of transnasal EGD. The clinical pathway for medical staff was evaluated as useful by 27, slightly useful by 3, and undetermined by 1 for confirmation of important points in safety management of transnasal EGD. There was no difference between the answers by doctors and nurses. The sample training course program of transnasal EGD at our department was considered useful.

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