Japan's age-adjusted colorectal cancer mortality rate has decreased since 1996. However, in 2016, it was the highest among the G7 countries. Although colorectal cancer screening was initiated with the fecal immunochemical test (2 day method) in Japan in 1992, it has not shown significant results.

The issues regarding colorectal cancer screening in Japan are as follows: (1) the rate of undergoing close examination is only 68.5% according to the Report on Regional Public Health Services and Health Promotion Services (2016), and (2) the screening rate is as low as 41.4% according to the Comprehensive Survey of Living Conditions (2016). Meanwhile, in the UK, organized screening has been conducted for colorectal cancer screening using the fecal occult blood test. The screening rate was over 50% in 2015, and the rate of undergoing close examination exceeded 80%. Additionally, screening with sigmoidoscopy was initiated in England. In the US, total colonoscopy is conducted once every 10 years for colorectal cancer screening, with the screening rate exceeding 60% in 2015. Consequently, the age-adjusted mortality rate of colorectal cancer has steadily declined in the UK and the US and is currently lower than that in Japan.

To further reduce the mortality rate of colorectal cancer in Japan, the screening rate and the rate of undergoing close examination after colorectal cancer screening by the fecal immunochemical test should be increased by the recommendation of screening to the population, including to those in occupational fields. Additionally, screening colonoscopy should also be considered.

Background: In esophagogastroduodenoscopy (EGD), drug-based sedation is useful in reducing pain experienced by the patient, but there are concerns regarding accidental complications. Consequently, there is a demand for methods other than sedative administration. In the present study, the effects of distraction by visual stimulation on subjects undergoing EGD were examined.

Subjects and methods: The subject population comprised 130 individuals who underwent EGD. Subjects in the control group rested for 15min before EGD, whereas those in the distraction group rested and watched videos of natural scenes under indirect lighting for 15min before EGD. Vital signs and autonomic nervous function were measured before, during, and 10min after EGD.

Results: Before EGD (after resting for 15min), the heart rate and blood pressure were significantly lower in the distraction group than in the control group (p < 0.05). The heart rate 10min after EGD was significantly lower in the distraction group than in the control group (p < 0.05). The log high-frequency power was significantly higher before EGD (after resting for 15min) and 10min after EGD completion, and the low-frequency power/high-frequency power ratio was significantly lower after resting for 15min in the distraction group than in the control group (p < 0.05 and p < 0.001, respectively).

Conclusions: These findings imply that distraction before EGD by visual stimulation is effective for the stability of hemodynamics and autonomic nervous function.

We had started the upper gastrointestinal barium X-ray radiography (UGI-XR) on mass screening for gastric cancer at individual clinics in Miyazaki City. However, increasing examinees and replacing the members of Gastric Cancer Committee of Miyazaki Districts Medical Association and the instrument of UGI-XR had been a challenge for us. For these reasons, we started ABC classification system for gastric cancer risk assessment (ABC classification) in 2013. Then, we reported the result of ABC classification for 5 years from 2013 to 2017. Consequently in 5 years, the number of examinees, examinations needed to be completed (%), examinations completed (%), detected cancers (%), early-stage cancers (%), positive predictive value, and necessary cost of detecting one cancer were 43,990, 16,078 (36.5%), 11,173 (69.5%), 124 (0.28%), 102 (82.3%), 0.8%, and approximately 3,930,000 yen, respectively. The problems that ABC classification had were as follows: the ratio of examinations needed to be completed and examinees was high, and positive predictive value was low. However, ABC classification had more advantages: the number of examinees was high, several cancers were detected, the ratio of detected cancers and examinees was high, the ratio of early-stage cancers and all cancers was high, and the cost was cheap.

Eosinophilic esophagitis (EoE) has been considered a rare disease in Japan, but the number of reports has been increasing in recent years. Endoscopic findings in screening endoscopy from December 2010 to January 2019 at our hospital and endoscopy findings characteristic of EoE and biopsy from esophageal epithelium 90 cases were diagnosed as suspected EoE (15 or more/HPF). Among them, 67 cases whose symptoms were confirmed were classified into the symptomatic and asymptomatic groups, and clinical images and endoscopic findings were examined. The clinical findings showed that compared with the asymptomatic group, the symptomatic group had a younger age at diagnosis and had more erosive reflux esophagitis. Endoscopic findings showed a significant increase in the concentric rings in the symptomatic group. The number of cases of EoE reported in recent years has increased, and it is assumed that the chance of encountering endoscopic findings characteristic of EoE will increase in the endoscopic screening of gastric cancer in population-based screening in the future. In that case, unnecessary biopsy should be avoided, but it is important to reconfirm the presence of symptoms and consider therapeutic intervention with EoE in mind.

We defined "interval colorectal cancer," conducted total colonoscopy (TCS) within 3 years, and detected advanced cancer this time. We reviewed its characteristics to improve the accuracy of the colonoscopy. For eight years from April 2010 to March 2018, 43,852 TCS cases were examined at our center, and 3,020 malignant tumors were detected; the prevalence of interval advanced cancers was 19 (0.6%). Several of them were detected in the site with deep haustra, such as Cecum or Ascending colon or poorly extended lesion due to diverticulum. Additionally, there were several other reasons such as poor preparation before colonoscopy, lack of information on the surgical procedure after surgery, occurrence in the diverticulum, and adenoma progression. To improve the accuracy of TCS, which is a secondary precision examination for colorectal cancer screening, we must conduct the colonoscopy by keeping in mind the poor observation site of the colon.

Introduction: Advanced hepatic fibrosis is an essential prognostic indicator in patients with fatty liver disease, including those with non-alcoholic fatty liver disease.

Objective: The present study aimed to evaluate the identification of patients with advanced hepatic fibrosis in individuals who underwent abdominal ultrasonography during a complete medical checkup.

Patients and Methods: Among 1141 individuals who underwent abdominal ultrasonography during a complete medical checkup between January and December 2018, the FIB-4 index (calculated from ALT and AST levels, platelet count, and age; the severity of hepatic fibrosis was categorized according to scores of <1.3, 1.3–2.66, and ≥2.67) was used to identify patients with advanced hepatic fibrosis, and factors related to advanced hepatic fibrosis and the relationship between advanced hepatic fibrosis and ALT levels were examined.

Results: Overall, 42 patients with advanced hepatic fibrosis were identified (3.7%), and factors associated with advanced hepatic fibrosis included male sex, fatty liver, HbA_1c of >6.5%, and lifestyle-related diseases such as hypertension. Advanced hepatic fibrosis was not associated with ALT levels, with 26.2% of patients with advanced hepatic fibrosis exhibiting ALT levels of <51 IU/L, suggesting that abnormalities are not identified during the checkup.

Conclusion: ALT levels alone are insufficient in identifying patients with advanced hepatic fibrosis among those with fatty liver disease. Therefore, simple and non-invasive diagnostic methods, such as the FIB-4 index, should be used during routine medical checkups to diagnose hepatic fibrosis.

We reported five patients with primary duodenal tumor diagnosed at endoscopic gastric cancer screening. Four patients had the superficial non-ampullary duodenal epithelial tumors (SNADT), and one had duodenal-type follicular lymphoma. All tumors were located at the descending portion of the duodenum. We conducted endoscopic treatment in three SNADT patients, surgical resection in one SNADT patient, and chemotherapy in one lymphoma patient. All patients are alive without recurrence after the treatment.

It is necessary to observe the descending portion of the duodenum at the time of endoscopic gastric cancer screening.