Nihon Shoukaki Gan Kenshin Gakkai zasshi
Online ISSN : 2185-1190
Print ISSN : 1880-7666
ISSN-L : 1880-7666
Volume 53, Issue 6
Displaying 1-10 of 10 articles from this issue
Prefatory Note
Original article
  • Tomomi YAMAMOTO, Tomonori ANBO, Shinichi TANAKA, Hajime HOSOKAWA, Hide ...
    2015 Volume 53 Issue 6 Pages 759-765
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    Background: In the standard method of upper gastrointestinal imaging in cancer mass screening, it is necessary to rotate quickly to the right three times at the beginning of the process in order to achieve uniformity in the barium coat thickness. But, in practice, we often experience cases in which it is difficult to perform this action. Subjects and Method: The capability of the quick three times rotations within 40 seconds was evaluated in the non-movie oriented subjects of 1,665 and the movie oriented subjects of 1,631. Results: 1,237 of the non-movie oriented 1,655 and 1,433 of the movie oriented 1,631 were able to be rotated successfully (74.3% vs 87.9%, p<0.01). The success ratio became lower with age in both groups. The movie orientation was significantly effective in the 75 years of age or younger, but especially in the 75 years of age or older subjects, the effect of orientation movement was minimal. Conclusion: The orientation movie enables a higher success ratio of the quick triple rotation. But it is a matter of debate whether to apply the standard method including the quick rotations equally to older subjects in the imaging of the gastric cancer screening.
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  • Tsunenobu SATO, Kazuya YAMAGUCHI, Sonomi SUGIYAMA, Asana AKABANE, Kana ...
    2015 Volume 53 Issue 6 Pages 766-774
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    Backgrounds: Although the patients classified into Group A in ABC classification are regarded as being at low risk of gastric cancer, it raises the concern that the incidence ratio of gastric mucosal atrophy is higher than expected in the elderly.
    Materials and Methods: We compared, according to age, ABC classification and the levels of gastric mucosal atrophy determined by radiography screening. 1168 participants of population-based screening for gastric cancer conducted at Village C in Chiba Prefecture in March 2013 were enrolled. Participants with a history of Helicobacter pylori (HP) eradication, under treatment for gastric disease, gastroesophageal reflux disease or gastric resection were excluded by interview form. Blood was collected from participants on the day X-ray examination was performed after obtaining written informed consent.
    Results: In the elderly group (70 years or older), the rate with gastric mucosal atrophy was 40-50%, even though the participants were classified into Group A. Evaluation utilizing HP antibody (less than 3 U/ml) or Pepsinogen method was inappropriate to exclude gastric mucosal atrophy.
    Conclusions: A higher incidence of gastric atrophy was observed in the elderly who were originally classified into Group A by ABC classification. Additional diagnosis by imaging is required to exclude severe atrophic gastritis.
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  • Ayaka SAKANO, Nori MATSUMOTO, Hitoshi KURUSHIMA
    2015 Volume 53 Issue 6 Pages 775-781
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    The pepsinogen (PG) method is useful for identifying the population at high risk of gastric cancer, however not only patients positive for PG but those who are negative also often develop gastric cancer. Recently, among patients diagnosed as gastric cancer from the complete medical checkup in our hospital, we examined PG levels in 52 patients whose pretreatment PG level was known. Of 52 patients, 30 were positive for PG (57.7%) and 22 were negative (42.3%). The incidence of gastric cancer was higher in patients associated with atrophy classified as O-1 and O-2. Open-type atrophy was observed in 90.0% of PG-positive patients and 50.0% of PG-negative patients. Among 50 patients with a confirmed pathological diagnosis, 37 had differentiated cancer and 13 had undifferentiated cancer. According to tumor differentiation, 64.9% of patients were positive for PG in the differentiated-cancer group but 53.8% were negative in the undifferentiated-cancer group. We also studied PG levels in 20 gastric cancer patients who were negative for PG and as a result, 75.0% of them showed a low level of PG I (40 or lower) or a low PG I/II ratio (4 or lower). Although PG-positive patients are at high risk of gastric cancer, it may be important to take account of the possibility of gastric cancer in patients negative for PG.
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  • Tadashi SOGA
    2015 Volume 53 Issue 6 Pages 782-791
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    With the introduction of risk diagnosis in population-based regional screening for gastric cancer, the following additional criteria were proposed to reduce the prevalence of patients in Group pseudo-A: pepsinogen (PG) I level ≤ 35 ng/mL, PGIIlevel ≥ 15 ng/mL, Helicobacter pylori (HP) antibody titer of 5-10 U/mL, or a history of HP eradication. If examinees assigned to Group A, based on the conventional criteria, meet any of the additional criteria, they are subjected to detailed examination by using endoscopy (detailed Group A examination). In 2013, a total of 17,325 people underwent the screening program. Detailed examination was required in 40.9% (4,052/9,916) of Group A subjects. Of these patients, 45.5% (342/751) had atrophic gastritis and 4 had gastric cancer.
    We estimated that Group pseudo-A subjects accounted for 11.1% of the total number of Group A subjects without an HP eradication history. The ratio of subjects with gastric cancer to subjects requiring detailed examination in Group pseudo-A was 1.65%, comparable to the ratio in Group C. The additional criteria were satisfied by most, but not all, Group pseudo-A subjects. Furthermore, the number of examinees requiring detailed examinations in Group A was high, with many pseudo-positive subjects. Therefore, refinements of the additional criteria are being considered.
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Experience
  • Toshio OHIWA, Hisao OHIWA, Shinji KITAGAWA, Daisuke TSURUMARU, Minako ...
    2015 Volume 53 Issue 6 Pages 792-800
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    In order to validate the efficacy of a gastric mass survey in Fukuoka district, we retrospectively recruited 121 consecutive gastric cancer patients detected in a gastric mass survey, and another 744 consecutive cases detected at Ohiwa Surgery Clinic (OSC) between 1965 and 2012, all of whom were surgically resected and pathologically proven. We compared the clinicopathological factors between the two groups, including macroscopic morphology, histological subtypes, lesion location within the stomach, and prognosis.
    Of these 865 cases in total, early gastric cancers accounted for 64% (78/121), and 53% (394/744) in the mass survey and OSC groups, respectively. As for macroscopic morphology of early gastric cancer, protruded type was more frequently found in the mass survey group than in the OSC group. Sixteen out of 78 early gastric cancers in the mass survey group were incidentally found during the scrutiny, apart from the abnormality suggested in the mass survey. In other words, 79% (62/78) of early gastric cancers were correctly suggested in the mass survey. Depressed type morphology without fold convergence, and upper and lower locations were the factors related to misdiagnosis in the mass survey.
    Histologically, there was a tendency that early cancers were of differentiated subtype, whereas advanced cancers were of undifferentiated subtype, showing no significant difference between the groups.
    The 5-year survival rate of the mass survey group was 83.8%, which is better than that of the OSC group (71.6%).
    In conclusion, we consider that the gastric mass survey in Fukuoka district is useful in terms of early cancer detection.
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  • Naohiko HARADA, Katsuya HIRAKAWA, Shinji KITAGAWA
    2015 Volume 53 Issue 6 Pages 801-809
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    An endoscopic individual screening program for gastric cancer in Fukuoka city has been carried out since June 2000. This program has been performed by double check reading system by registered facilities and members of the Committee of Gastrointestinal Cancer Screening. A total of 189,429 examinees have been screened by the program from 2000 to 2013. The number of recalled examinees was 10,005, and 874 gastric cancers were detected by the program. The rate of gastric cancer detected by the program was 0.46%. Accuracy control and standardization are the minimum requirements for endoscopic screening for gastric cancer.
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Case report
  • Katsuhiko MITSUZAKI, Katsuhiko MATSUDA, Kumi FUKUNAGA, Moritaka SUGA, ...
    2015 Volume 53 Issue 6 Pages 810-816
    Published: 2015
    Released on J-STAGE: December 16, 2015
    JOURNAL FREE ACCESS
    The patient was a 70-year-old woman who underwent computed tomography colonography (CTC) during colon cancer screening. Bowel dilation was achieved using an automated carbon dioxide insufflator, and no subjective symptoms such as abdominal pain were noted either during or after the procedure. Imaging findings showed poor dilation associated with high-grade diverticulosis of the sigmoid colon, though no free gas, suggesting perforation, was observed. From the day after the investigation, the patient became aware of mild lower abdominal pain and developed a mild fever, but these were left untreated. Thereafter, the lower abdominal pain and fever persisted, and on Day 6 after the investigation, contrast CT and MRI showed abscess formation due to perforation of a sigmoid diverticulum. The patient was diagnosed with acute generalized peritonitis and underwent emergency surgery. Although CTC is a minimally invasive and safe investigation, it has been known to cause colonic perforation in rare cases. It is important to have an understanding of this, while learning the associated risk factors and preventive strategies. It is also important to aim for early detection of perforations, and a check-and-follow system should be developed for cases in which accidents occur. There have been no reports to date of cases of colonic perforation caused by screening CTC in Japan, so we are reporting this instructive case.
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Abstracts of local chapters
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