Nihon Shoukaki Gan Kenshin Gakkai zasshi
Online ISSN : 2185-1190
Print ISSN : 1880-7666
ISSN-L : 1880-7666
Volume 60, Issue 1
Displaying 1-11 of 11 articles from this issue
Prefatory Note
Report from the Chair of the 59th Annual Meeting
Review Article
  • Satoshi HATTORI
    2022 Volume 60 Issue 1 Pages 3-13
    Published: January 15, 2022
    Released on J-STAGE: January 17, 2022
    JOURNAL RESTRICTED ACCESS

    In medical research, statistical methods have been widely utilized. With enhanced expectations for real-world data, highly sophisticated statistical methods have recently been successfully introduced in practice. However, inappropriate application of statistical methods may be observed. Therefore, statistical thinking and reasoning should be appropriately shared among clinical researchers. In this study, we provide an introductory explanation of the statistics. In contrast to a recent randomized clinical trial and a recent observational study evaluating the effectiveness of endoscopies, fundamental ideas behind statistical methods are widely used in clinical research. This is the first part in a series of two successive lectures.

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Original article
  • Nobutake YAMAMICHI, Takeshi SHIMAMOTO, Chigaya HIRANO, Yu TAKAHASHI, C ...
    2022 Volume 60 Issue 1 Pages 14-20
    Published: January 15, 2022
    Released on J-STAGE: January 17, 2022
    Advance online publication: August 31, 2021
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    Purpose: Mucosal atrophy and enlarged folds of the stomach diagnosed by double-contrast upper gastrointestinal barium X-ray radiography (UGI-XR) are two major features of Helicobacter pylori (H.pylori) -induced chronic gastritis. A prediction ability of gastric cancer development based on these two features is currently required.

    Methods: Generally healthy UGI-XR examinees, without a history of gastrectomy, previous H.pylori eradication, or use of gastric acid suppressants were prospectively observed for 10 years from 2010 to 2020.

    Results: Of the 6,433 subjects enrolled, 1,936 (30.1%) had mucosal atrophy and 1,253 (19.5%) had enlarged folds. During the 10-year prospective follow-up, gastric cancer developed in 17 subjects, of whom 15 had mucosal atrophy and 11 had enlarged folds. Kaplan-Meier analyses with log-rank testing revealed that the presence and severity of UGI-XR-based mucosal atrophy are useful indicators for future gastric cancer development (p< 0.0001, p< 0.0001), and the same is true for the presence and intensity of enlarged gastric folds (p< 0.0001, p< 0.0001).

    Conclusion: Mucosal atrophy and enlarged folds of the stomach, diagnosed by UGI-XR, are both useful indicators of future gastric cancer development.

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  • Takashi NISHIKAWA, Eisuke YASUDA, Shinya WATANABE, Takeshi HAGIWARA, S ...
    2022 Volume 60 Issue 1 Pages 21-31
    Published: January 15, 2022
    Released on J-STAGE: January 17, 2022
    Advance online publication: October 31, 2021
    JOURNAL RESTRICTED ACCESS

    Background: The Japanese Society of Gastrointestinal Cancer Screening has published the guideline for gastric cancer screening using radiographic examination. The guideline defines the screening procedures and recommends supplemental images, if necessary, in addition to the routine examination. Additional radiographs are shot when a radiology technologist considers them necessary for the routine examination; however, their impact on improving diagnostic accuracy has not yet been assessed. Therefore, this study aimed to evaluate the utility of additional radiographs in obtaining accurate diagnoses.

    Materials and Methods: Twelve gastroenterologists were categorized into either the beginner or senior group, according to their clinical experience. Gastrointestinal (GI) series images from 40 patients who had undergone gastroendoscopy and acquired pathological diagnosis, if necessary, were obtained. Of these patients, 20 were diagnosed with gastric cancer, and the other 20 had benign lesions. The GI series radiographs were then randomly arranged and presented to the gastroenterologists. Sensitivities for gastric cancer were compared between the two gastroenterologist groups, and the supplemental images' contributions to accurate diagnoses were also assessed.

    Results: Median sensitivities for all gastroenterologists were 76.5% (mean: 71.6%) when supplemental images were given and 30.0% (mean: 41.7%) during routine examinations only, indicating a significant difference (P<0.05). In the senior group, median sensitivities with supplemental radiographs were 93.0% (mean: 92.0%), and median sensitivities with routine examination alone were 80.0% (mean: 80%), indicating no statistical significance. In the beginner group, median sensitivities with supplemental radiographs were 47.0% (mean: 57.1%), and median sensitivities with routine examination alone were 20.0% (mean: 14.3%), indicating a statistically significant difference (P<0.05).

    Conclusions: In the senior group, sensitivity enhancement with the implementation of supplemental images was not observed. However, the beginner group showed an increase in sensitivity with the application of supplemental images.

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  • Hiroki TANAKA
    2022 Volume 60 Issue 1 Pages 32-40
    Published: January 15, 2022
    Released on J-STAGE: January 17, 2022
    Advance online publication: July 31, 2021
    JOURNAL RESTRICTED ACCESS

    Objective (background): Pancreatic cancer is known to have a poor prognosis. Only 20-30% of patients have resectable tumors. Therefore, it is important to identify resectable pancreatic cancer efficiently. This study aimed to clarify the diagnostic opportunity and clinical features of resectable pancreatic cancer.

    Subjects and methods: The authors reviewed diagnostic opportunities and clinical features of 246 patients (74 with resectable and 172 with borderline/unresectable tumors) who were diagnosed with pancreatic cancer at Suzuka General Hospital from January 2013 to November 2019 (a single center retrospective analysis).

    Results: Resectable pancreatic cancer was efficiently diagnosed by medical check-up (10/13, 76.9%) or regular examination for intraductal papillary mucinous neoplasm (IPMN) (5/5, 100%). Multivariate logistic regression analyses revealed that no symptoms at the diagnosis {Odds ratio (OR) 6.21; 95% CI 2.88-13.4, P<0.001}, tumor confined to the pancreatic head (OR 3.13; 95% CI 1.60-6.11, P<0.001) were positive predictors of resectable pancreatic cancer, and new onset or worsening of diabetes (OR 0.31; 95% CI 0.14-0.71, P<0.01) and CA19-9≥37 IU/ml (OR 0.44; 95% CI 0.20-0.96, P=0.039) were negative predictors. Among risk factors for pancreatic cancer, only 25.8% (8/31) of IPMN and neither pancreatic cysts nor chronic pancreatitis were detected before the diagnosis of pancreatic cancer.

    Conclusions: To detect resectable pancreatic cancers, it is important to diagnose pancreatic cancer when patients are asymptomatic and CA19-9 negative. Risk factors such as IPMN were often not recognized before the diagnosis of pancreatic cancer; thus it is necessary to detect risk factors more efficiently.

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Experience
  • Kenichiro MAJIMA, Koichi NAGATA, Masanori FUJIWARA, Yosuke MURAKI
    2022 Volume 60 Issue 1 Pages 41-52
    Published: January 15, 2022
    Released on J-STAGE: January 17, 2022
    JOURNAL RESTRICTED ACCESS

    Computed tomography (CT) colonography is a highly useful diagnostic examination method for colorectal cancer screening. However, one of its disadvantages is that it cannot be used to easily perform diagnoses in the anorectal region. To clarify the optimal considerations for accurately diagnosing anorectal lesions, we retrospectively compared CT colonography images with colonoscopic images. Fifty-five cases in which colonoscopic images could be obtained for comparisons included 1, 3, 3, and 48 cases with false-negative, false-positive, true-positive, and true-negative findings in the anorectal region, respectively. The false-negative case involved a type 4 advanced signet ring cell carcinoma, while the false-positive cases involved hypertrophied anal papillae, benign polyps, and suspected residues. The findings that could result in false-positive assessments included ridges caused by longitudinal folds that converged at the anal canal and pseudo-elevation of lesions as a result of the use of a rectal catheter balloon. Candidates for true-positive lesions were those with lesions at some distance from the anus and lesions > 5 mm in size. Notably, lesions very close to the anus may be deformed or obscured by an inflated balloon. Contrastingly, some lesions may be concealed in the anal canal and obscured due to the deflation of the balloon. The findings of this report indicate the importance of recognizing the greater likelihood of false-negative and false-positive findings in the anorectal region. Physicians needs to interpret anorectal region carefully.

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