Since 2011, the Okayama Health Foundation has been attempting to identify patients who are at risk of gastric cancer by classifying the background gastric mucosa to detect gastritis due to H. pylori infection by X-ray findings using barium X-rays. Gastric barium X-rays of 15,323 people who underwent local gastric cancer screening in 2011 were obtained; their background gastric mucosae were classified into three groups by X-ray findings: normal (N), atrophic gastritis (AG), and rugal hyperplastic gastritis (HG). Of the patients screened, 70.3% were classified in the N group, 28.0% in the AG group, and 1.7% in the HG group. The detection rate of gastric cancer was 0% in the N group, 0.42% in the AG group, and 1.98% in the HG group; detection rates were significantly higher in the AG and HG groups compared to the N group (P<0.01). The positive predictive values were also high in the AG and HG groups, at 5.5% and 3.9%, respectively. We conclude that the identification of patients who are at risk of gastric cancer from H. pylori infection by X-ray findings using barium X-rays for population-based gastric cancer screening can result in improved detection of gastric cancer.

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During the period from April 2006 to March 2012, subjects of 26,611 people underwent examination with a small-diameter endoscope for stomach cancer screening at Kyoto Second Red Cross Hospital. Gastric cancer was detected using the small-diameter endoscope in a total of 90 cases: 81 cases of early cancer, 6 cases of advanced cancer, and 3 cases of unknown depth of invasion, in the 6 years. The cancer detection rate and early gastric cancer rate were 0.34% and 90%, respectively, which is higher than the national average detection rate. The biopsy rate and biopsy predictive value were 21.8% and 1.4%, respectively, in Fiscal 2006, but in 2011, they improved by 10.1% and 3.3%. Endoscopic anamnesis of less than 3 years was recognized in 51 cases of 90 detected cancers, and the false-negative rate was 56.7%. 92.2% of false-negative cancer was early cancer, and in most of these cases, endoscopic therapy was possible. In stomach cancer screening using a small-diameter endoscope, accuracy is sufficient, so a small-diameter endoscope was considered to be useful in screening for stomach cancer.

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We investigated the comparative study of the accuracy of the first reading shadow, the second reading shadow, and the third reading shadow in the Kanazawa-shi multi facilities endoscope medical examination.
The item that we examined was cancer discovery rate, recall rate, positive- predictive value, and overlooking rate. The total of the endoscope medical examination was 52540 between 2008 and 2012, and the detected cancer was 172 examples (0.33%). Cancer discovery rate of the first reading shadow was 0.30%, and recall rate was 1.1%, positive-predictive value was 29.2%, and overlooking rate was 8.7%. The second reading shadow each was 0.30%, 2.2%, 15.9%, and 7.6%.The third reading shadow each was 0.31%, 1.2%, 21.1%, and 4.7%. Recall rate of the first reading shadow was the lowest, and positive-predictive value of the first reading shadow was the highest. Overlooking rate of the third reading shadow was the best with significant difference. Overlooking rate of the second reading shadow was superior to the first reading shadow but there was not the significant difference. Recall rate and positive-predictive value of the second reading shadow were inferior together. The third reading shadow that was original method of Kanazawa-shi was useful from the above-mentioned point.

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ABC classification for gastric cancer risk evaluation (ABC risk examination) is a serological test for predicting the incidence of gastric cancer by combining serum anti-Helicobacter pylori (Hp) antibody titer with the Pepsinogen test. Our institute introduced the ABC risk examination as an optional examination of human dock in 2011.4 and a total of 993 patients have undergone this test by 2012.3. Thereafter, we investigated how ABC risk examination influenced the consultation decision concerning gastric cancer screening by a mail-back questionnaire study. There were 423 replies to the 995 questionnaires sent out and 365 subjects aged over 40 years old were included in this study. As a result of recognition of their own risk for gastric cancer through ABC, 42.0% of Group A (Hp-,PG-), 57.6% of Group B (Hp+, PG-) and 82.7% of Group C+D (PG+) understood the importance of gastric cancer screening. This tendency was present in the subjects who had not received the gastric cancer screening yet. The result suggested that ABC risk examination might contribute to enhancing the motivation for participating in the gastric cancer screening program. Therefore, we should construct an integrated system of ABC risk evaluation with the gastric cancer screening program to lead the examinees to receive the annual screening examination and also direct them to understand the meaning of gastric cancer risk evaluation.

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Objective: To compare the CT colonography performance of a trained radiographer with the CT colonography performance of a skilled physician.
Subjects and Methods: 2,342 asymptomatic average risk participants were referred for screening CT colonography. With 3D primary reading, two readers performed an endoluminal fly-through from anus to cecum and back again for supine and prone data sets. Transverse 2D and MPR views were used for problem solving. Results: In double-blind reading, the positive rate of CT colonography was 4.4% (103/2,342) and the positive predictive value was 89.3% (92/103) for lesions 6 mm or larger. Misdiagnoses were caused by careless positional shift in four participants and by misevaluating of lesion's CT value in one participant. The overall agreement between two readers was 99.8%.
Conclusions: By trained and experienced readers, CT colonography interpretation in double-read paradigm is not necessary for further improvement of accuracy. In CT colonography interpretation, positional shift of the lesion and air inclusion is important for efficient differentiation between polyp and faecal residues.

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Antithrombotic agent name, underlying disease, discontinuation of agent and determinator of discontinuation were investigated in 100 patients (86 males, 14 females, average age 68.3 y.o.) under antithrombotic therapy among 953 patients who underwent endoscopic upper GI cancer screening. One hundred patients were divided into two groups; 50 patients before and 50 patients after the explanation of antithrombotic therapy was added in the informed consent document in August 2010. The three most commonly administered agents were 59 aspirin, 16 warfarin, and 8 clopidogrel. Representative underlying diseases were 22 arrhythmia like atrial fibrillation, 17 old cerebral infarction, and 13 angina pectoris. Twelve patients (2 patients before and 10 patients after the informed consent) discontinued antithrombotic therapy by themselves, including 2 patients administered warfarin due to arrhythmia like atrial fibrillation who are considered to have a high risk of a thromboembolic event. After the explanation of antithrombotic therapy in August 2010, the number of patients who discontinued antithrombotic therapy by themselves was significantly higher than before the informed consent. The explanation of antithrombotic therapy in August 2010 was evaluated as inadequate to prevent discontinuation of the agent without a doctor's consultation. Corresponding to the new guideline of endoscopic procedures with antithrombotic agents in our department, patients have been informed that antithrombotic therapy should be continued generally. When a biopsy is needed, patients are referred to other medical institutes. Considering opinions of the doctors at other health check-up institutes, only when a doctor's permission for discontinuation of an agent is obtained, can the biopsy be performed after confirmation of the doctor's permission in every endoscopic procedure.

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