We reported that the examinees of Groups B, C, and D who had undergone the ABC classification system for gastric cancer risk assessment should be encouraged to do a follow-up endoscopic examination 3 years later. In this study, we aimed to evaluate whether the recommendation of a follow-up endoscopic examination 3 and 4 years later for the examinees is effective. We enrolled subjects who had been classified as Group B, C, or D in the ABC classification system in 2011 and 2012. We randomly selected 345 and 297 examinees for recommended and non-recommended groups, respectively, and we encouraged the former group to undergo a follow-up endoscopic examination in 2015. We evaluated the endoscopic examination rate after encouraging a follow-up endoscopic examination for 147 examinees in 2011 and 122 in 2012, who agreed at the time of follow-up surveillance 5 years later. There was no significant difference between the recommended group and the non-recommended group at 46.2% (91/197) and 39.7% (77/194), respectively. Even in Groups B, C, and D, there was no significant difference in the rates of follow-up endoscopic examination between the recommended group and the non-recommended group. Therefore, we concluded that encouraging examinees to undergo a follow-up endoscopic examination 3 and 4 years later was not effective. We consider that the examinees in Groups B, C, and D should undergo endoscopic examinations immediately after the classification and the encouragement for endoscopy should be given only when the first ABC classification has been made.
The benefits of a Helicobacter pylori checkup in young students were examined by screening 159 third-grade students at a junior high school in the Nara city of Japan. Many parents were also interested in the checkup. Five students were found to be infected. The H. pylori infection rate was 3.1%, and it was comparable to the previous nationwide reports. Considering the high incidence of family infection of H. pylori, we attempted to check the infection in families. Four family members in two families were examined and three members were found to be infected. One of them had undergone an eradication therapy. An H. pylori checkup in young people is expected to lead to the primary prevention of gastric cancer.
To reduce the mortality due to gastric cancer in the future, we aimed to perform a check for the Helicobacter pylori (H. pylori ) infection for the first time in the Iwate Prefecture. For 5 years, this check has been conducted in collaboration with A City, a Municipal Medical Association, and Iwate Prefecture Cancer Society as the examination institution from FY2015. The participants are generally the residents of A City who are 20,25,30,35,40 years old. Fecal H. pylori antigen testing is used for the primary examination. The primary examination rates were 43.2% (2,067/4,786) in 2015 and 39.8% (1,885/4,742) in 2016. An additional precise examination of those who were positive for the H. pylori antigen in the primary examination was performed in 81.2% (220/271) participants in 2017. This resulted in the successful eradication of H. pylori in 98.5% (194/197) via appropriate treatment. It is believed that continuing such examinations will contribute to reducing gastric cancer mortality and H. pylori infection. Herein, we investigated the relation between H. pylori infection and gastric mucosal change using an X-ray examination in 263 participants who simultaneously underwent population-based examination and fecal H. pylori antigen screening. In addition, when gastric X-ray images were examined for overlapping cases of the organized gastric cancer screening and a check of H. pylori infection in A City, 27 of 263 cases showed dissociated results: 3 of 27 (11.1%) without X-ray atrophy and the remaining 24 (88.9%) with antigen negative and X-ray diagnosed atrophy. The data suggest that irrespective of the H. pylori examination results, residents should undergo an X-ray examination for gastric mass survey.
The purpose of this study was to evaluate the examination quality of non-laxative computed tomography colonography (CTC) with modified dry preparation. Seven hundred sixty-four consecutive subjects who received a CTC were enrolled. Accuracy and bowel preparation quality were assessed retrospectively in non-laxative CTC. For the purpose of accuracy evaluation, we assessed the overall compliance rate to colonoscopy of CTC-positive subjects, positive predictive values, and inadequate study rate due to inadequate preparation or inadequate insufflation. For the purpose of quality evaluation, the volume of residual fluid or solid stool was graded by two blinded readers from 0 (no feces) to 3 (much amount of feces) in each colonic segment. The CT attenuation values of tagged residual stool or fluid were measured manually by recording the minimum attenuation values (in HU) in each colonic segment. The overall compliance rate to colonoscopy of CTC-positive subjects was 70.5%. The by-subject positive predictive value for CTC-detected lesions ≥6 mm was 64.1%, and inadequate study rate was 3.7%. As far as the subjects who could be reached and were followed up were concerned, the overall compliance rate to colonoscopy was 90.2%, and the by-subject positive predictive value was 90.9%. The percentages of segments that were assigned scores of 3 for residual stool and fluid were 10.5% and 4.5%, respectively. The mean CT attenuation values of tagging was 617.2 HU. Although non-laxative CTC had good accuracy with adenomas 6 mm or larger, a primary three-dimensional interpretation could be difficult because of much amount of solid stool in the endoluminal images.
A 41-year-old man was admitted to our emergency room because of increasing periumbilical pain, which appeared 10 hours after an X-ray examination for gastric cancer screening. Physical examination revealed rebound tenderness and muscular pain and muscular tension in the lower right abdomen. Laboratory studies showed a white blood cell count of 14,800/μL with 89.6 neutrophil and 6.83 mg/dL C-reactive protein levels. Plain computed tomography (CT) scan demonstrated barium retention in the appendix and barium leakage surrounding the appendix. Furthermore, the CT scan demonstrated increased fat density in the surrounding appendix. Based on the patient’s history, as well as the clinical and radiological findings, he was diagnosed with barium appendicitis. The patient received a laparoscopic appendectomy. The appendix appeared enlarged, forming an abscess in the mesoappendix and the localized peritonitis. He was discharged on the fifth day of developing appendicitis. Although barium appendicitis is a rare complication, it is important to consider the possibility of barium appendicitis as one of the causes of acute abdomen after an X-ray examination for gastric cancer screening. An X-ray examiner must recognize barium appendicitis as a complication after an X-ray examination for gastric cancer screening.