In order to raise the accuracy among radiologists, cases where evident lesions were undetected were presented. For each case of diagnosed early gastric cancer by group exam, indirect fluororadiography taken each year up to three years before diagnosis was reviewed again. Among early gastric cancer cases diagnosed by group exam over five years from 2006 to 2010, 113 cases that received medical checkups at this facility from the time cancer was diagnosed until three years before, were determined as continuous examinations, and targeted for consideration. Cases where evident lesions were undetected were set as sample cases.
Results of the consideration showed that 19 (16.8%) out of 113 cases were indicative of cases where evident lesions were undetected. Cases at a higher rate were in the U area, in the posterior wall and in 0-I types.

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We performed UGI screening for employees in the world's first dedicated vehicle for transnasal endoscopy(TNE). To make the screening more efficient, we introduced an innovative and novel method to perform TNE for subjects at high risk for gastric cancer (ABC method). In this medical checkup, from the blood tests of 1,050 candidates, gastric cancer risk assessment was judged and C group (150 persons) and D group (10persons) were extracted. And we performed transnasal endoscopy in 96 persons with their consent at the company. As a result, one early gastric cancer patient was detected.
Since we are able to perform further examination with transnasal endoscopy for limited subjects who were assigned to the high-risk groups, this novel method could be efficient in detecting even early gastric cancer.

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We examined colorectal cancer screening using sigmoidoscopy from fiscal year 2003 to 2011. Of 7224 cases, 5 (0.069%) were diagnosed as colorectal cancer, and 2 of them were fecal occult blood test negativity. Five (0.069%) were diagnosed as rectal carcinoid tumor, and all of them were fecal occult blood test negativity. Eighty-three (1.1%) were diagnosed as colorectal adenoma that requires medical treatment, and 57 of them were fecal occult blood test negativity or unconsulted. Three hundred and seventy-two (5.1%) were diagnosed as colorectal adenoma that requires progress observation, and 86 of them disappeared after the biopsy of screening sigmoidoscopy. As a result, the benefit by screening sigmoidoscopy was suggested in a total of 150 cases (2.1%) including 2 cases of colorectal cancer with fecal occult blood test negativity, 5 cases of rectal carcinoid tumor with fecal occult blood test negativity, 57 cases of adenoma requiring medical treatment with fecal occult blood test negativity or unconsulted, and 86 cases of adenoma requiring progress observation that disappeared after the biopsy of screening sigmoidoscopy.

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It is extremely important that we patternize the insertion method to master the total colonoscopy (TCS) insertion method. We use “the Video Conference Method” in Nikikai, and each of our members develops his or her own insertion method. By learning this way in Nikikai, I have also improved the ileocecum insertion rate (99.9%) and insertion time (median time 2'57”) while maintaining the safety and comfort of TCS, which confirmed the usefulness of “the Video Conference Method”.

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A 62y.o. male underwent transnasal EGD for upper gastrointestinal cancer screening. In the middle esophagus, rough mucosa with slight redness was observed under white light (WL) though clear identification of the lesion was difficult. It was revealed as a relatively homogenous brownish area under narrow-band imaging (NBI) though lumination was too poor to evaluate the entire lesion. On the oral side of the brownish area, dilated intra-epithelial papillary capillary loops (IPCLs) were recognized as brownish dots, highly suggestive of superficial esophageal cancer (T1a-EP). Pathological finding of the biopsied specimen was high grade intraepithelial neoplasia (HGIN). Endoscopic examination with lugol stain was not performed with the ultrathin scope. These findings were further investigated with a high-resolution magnifying scope in other medical institutes. Depressed lesion at 50mm was identified under WL, in which dilated IPCLs were recognized under NBI. Dilated IPCLs were observed densely on its anal side, and sparsely on its oral side. The boundary of the lesion could be estimated with the distribution of dilated IPCLs. The pattern of dilated IPCLs was diagnosed as type B1, suggesting superficial esophageal cancer (T1a-EP/LPM). Another depressed lesion at 5mm was revealed as a brownish area of dilated IPCLs under NBI in the upper esophagus. The pattern of dilated IPCLs was diagnosed as type A, suggesting HGIN. Both lesions were identified with lugol stain as lugol unstained areas. The lesions were treated with endoscopic submucosal dissection (ESD) and endoscopic mucosal resection (EMR) in the middle and upper esophagus, respectively. Pathological diagnosis of the endoscopic resected specimen was SCC, 55×35mm/75×52mm, 0-IIc, pT1a-LPM, INFb, ly0, v0, pHM0, pVM0 and HGIN, 5×3mm/21×14mm, 0-IIb, ly0, v0, pHM0, pVM0 in the middle and upper esophagus, respectively. Observation under NBI was reported to increase the sensitivity of superficial esophageal cancer both under ultrathin and high-resolution magnifying scopes. The specificity of NBI observation depends on the familiarity of the endoscopists, indicating that the learning on NBI findings is important as well as careful observation. Some investigators recommend the usage of lugol stain as well as image-enhanced endoscopy (IEE) to identify tiny lesions of superficial esophageal cancer especially for high risk patients. Recently newly developed ultrathin scopes have been reported to have a resolution compatible with a high resolution standard scope at a short observation distance. Observation with IEE using new ultrathin scopes is expected to improve both the detection and differentiation of superficial esophageal cancer.

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