Currently, the discussions on the use of total colonoscopy (TCS) for population-based colorectal cancer screening are ongoing. In this review, we describe the problems that need to be addressed before screening for population-based colorectal cancer with TCS can be initiated, and further discuss the feasibility of this screening approach. The primary problems which need to be addressed are as follows: ensuring the safety of TCS; proving its efficacy in colorectal cancer screening; improving its recommendation status in guidelines, acceptability, and processing capacity; and discussing the interval of colorectal cancer screening by TCS, cost, premedication during TCS, and the training of colonoscopists as medical examiners. Solving all these problems in advance is challenging. Ultimately, colonoscopists need to acquire skills to perform an examination safely, accurately, reliably, and comfortably while being rapid. Mastering all the skills required to become a true colonoscopist could be difficult.

Summary: Pancreatic cancer (PC) is a fatal disease with a poor prognosis and an increasing morbidity and mortality. To improve the prognosis, it is important to identify lesions when they are sized 1 cm or less, as these have a relatively good prognosis in PC. Among the many identification modalities, endoscopic ultrasonography (EUS) is significantly superior to other techniques at detecting small PC. For detecting PC at an early stage, it is important to screen high-risk individuals with abdominal ultrasonography in the clinic to identify indirect findings, such as cysts and pancreatic duct dilatation. These patients then can be referred to a tertiary referral hospital to undergo EUS through the regional medical network. However, at present, EUS is not sufficiently widespread in general clinical practice, and further widespread use of EUS is necessary to achieve early detection of PC.

The direct forward viewing radial EUS is a scope developed to allow simultaneous examination of the upper gastrointestinal tract and the biliary-pancreas. This scope is less invasive and more operable than the conventional oblique viewing EUS, making it an ideal endoscope for PC screening.

The direct forward viewing radial EUS has the potential to induce a paradigm shift in future cancer preventive medicine by allowing new techniques, such as simultaneous screening of gastric and pancreatic cancer. Moreover, it could act as a trigger, promoting the widespread utilization of EUS in the future.

Aims: We examined the accuracy of diagnosing gastritis in barium-contrasted radiography, with or without referring to the results of the serum anti-Helicobacter pylori (H.pylori) antibody test. We also evaluated the effect of a consensus meeting on the accuracy and discussed its usefulness in education.

Methods: We recruited people from the participants of health check-up tests in Taga town, and the candidates of the study gave informed consent. We collected upper gastrointestinal X-ray pictures, history of H. pylori eradication therapy, and the results of a serum anti-H. pylori antibody test of the subjects. Six radiologists diagnosed background gastric mucosa and classified the stomach into gastritis and normal. Two radiological diagnoses were made in each participant with or without referring to the result of the serum antibody test (Diagnosis 1 and 2). Thereafter, a consensus meeting was held, and a consensus diagnosis was made among the six radiologists on each participant. Over one month after the consensus meeting, two more radiological diagnoses were made in the same way as done previously (Diagnosis 3 and 4), but the order of the subjects was randomly changed. If the diagnosis was the same as the consensus diagnosis in each subject, we evaluated that the radiologist diagnosed correctly.

Results: Fifty-four X-ray series of 52 subjects were included in the study. Of them, 34 and 19 stomachs were diagnosed as normal and with gastritis, respectively. We held a consensus meeting, and consensus diagnoses were made in 53 stomachs (98.1%). The mean accuracy ± standard deviation (%) of diagnosing background gastric mucosa in the six radiologists were 81.1±15.0, 91.8±9.6, 87.4±4.7, 96.5±3.7 in Diagnosis 1, 2, 3, and 4, respectively. The mean accuracy significantly elevated from Diagnosis 1 to 2, 3 to 4, and 1 to 4 with reference to the results of the antibody test (P<0.05). However, the variance of accuracy in diagnosis significantly changed from Diagnosis 1 to 3, and 1 to 4 (P<005).

Conclusion: The accuracy of diagnosing gastritis in radiography was significantly elevated with reference to the results of the antibody test. The standard deviation of diagnosis decreased after the consensus meeting with a significantly changed variance. These procedures were thought appreciable for the education of radiologists.