From an experience in ultrasonic examination of over 30 years, I summarize the history of the development of the ultrasonic diagnostic equipment and changes in the examination system of the ultrasonic diagnosis. The functions required for future ultrasonic diagnostic equipment are also explained. The objectivity of ultrasonography has increased owing to the development of ultrasonic diagnostic and peripheral equipment. Using this manual, the objectivities of ultrasonic screening results and judgment categories have dramatically improved. We are now ready to perform credible ultrasound screening. Henceforth, using this manual at many examination facilities would be key for quality control.

Herein, I summarize the history of the discovery of Helicobacter pylori (H. pylori) in the gastric mucosal background on barium X-ray radiography and the future perspectives on gastric cancer screening in Japan. H. pylori was first reported in 1983, and an antrum-type acute gastric mucosal lesion (AGML) was proven to be a clinical manifestation of acute H. pylori infection in 1995. In 1996, the Updated Sydney System was proposed to unify microscopic diagnoses of the gastric mucosa. In 1997, Uemura et al. reported a relationship between H. pylori infection and gastric cancer and suggested the possibility of gastric cancer prevention with eradication therapy. We first reported the diagnosis of H. pylori infection obtained using barium X-ray radiography in 1999 and proposed that examination of the gastric mucosal background should be included in gastric cancer screening in 2007. A large-scale cohort study is currently underway to determine if we can prolong the duration of screening in H. pylori-naïve patients. The efficiency of endoscopic gastric cancer screening is expected to worsen in the future because the prevalence of H. pylori infection is decreasing. Screening using barium X-ray radiography or the ABC method before endoscopic examination is expected to improve the efficiency of endoscopic gastric cancer screening. Gastric cancer screening programs should be designed in combination with these methods, according to the characteristics of the community. Because the sensitivity and specificity of gastritis screening are expected to be higher (>90%) than those of conventional gastric cancer screening using barium X-ray radiography, I propose that conventional gastric cancer screening should be shifted to gastritis screening.

Although the regulatory environment surrounding clinical research has changed significantly, whether it has fully permeated clinicians is unclear. Therefore, this review summarizes the latest revisions to the regulations that clinicians should be aware of. Using medical record information in observational research and providing data to other institutions require patient consent under the Act on the Protection of Personal Information. However, academic or public health exceptions are applied, and research can be conducted using opt-out. In addition, under the recently revised Ethical Guidelines for Medical and Health Research Involving Human Subjects, the ethics review committee became an independent organization, and the principal investigator became the person responsible for the research. Consequently, multicenter research was conducted under a single review, and the research proceeded smoothly. In addition, research cooperation organizations were newly defined, making it easier to collect samples and information from more organizations in multicenter research.

The current status of gastric cancer screening in the Gunma Prefecture and introduction of endoscopic screening have been reported. Endoscopic screening was introduced in 26 of the 35 municipalities in the Gunma Prefecture, accounting for 96% of the prefecture’s population. The municipalities that introduced endoscopic screening before revising the gastric cancer screening guidelines implemented it similarly to X-ray screening for people aged ≥ 40 years every alternate year, while those that introduced it after 2016 implemented it for those aged ≥ 50 years every alternate year, in accordance with the guidelines. The participating facilities are accredited by a specialized committee of the medical association to which each municipality belongs.

Secondary reading of the images was also conducted in a manner tailored to the current situation in each municipality. A total of 102,371 people underwent screening, 69,678 of whom opted for endoscopic screening, a proportion of 68% in 2018.

[Objective] Sufficient withdrawal time is an indicator of high quality for colonoscopy. The present study was aimed at investigating the effects on the withdrawal time and polyp detection rate (PDR) following a withdrawal time recommendation of at least 6 min and report the recording of withdrawal times.

[Participants and Methods] This study examined the withdrawal time and PDR from 1,231 opportunistic colonoscopy screening procedures undertaken between October 2017 and March 2019. Data on outcome measures were collected before the recommendation of the withdrawal time, after the recommendation of the withdrawal time, and after the withdrawal time recording had begun.

[Results] Endoscopist A had a mean withdrawal time (MWT) in normal colonoscopy of 3 min 13 s before the recommendation of the withdrawal time, which extended to 3 min 48 s and 4 min 19 s after the recommendation of the withdrawal time and after the withdrawal time recording had begun, respectively. Endoscopist B had a significantly extended MWT from 4 min 0 s before the recommendation to 5 min 49 s after the recommendation. Endoscopists C-E and F had MWTs of 6 and 8 min before the recommendation, respectively. They showed no significant MWT change. Endoscopist G had a significantly shortened MWT from 9 min 13 s before the recommendation to 7 min 22 s after the recommendation. Overall, endoscopists had a significantly extended MWT from 5 min 35 s before the recommendation to 6 min 26 s after the recommendation. The PDR did not increase significantly for any endoscopist.

[Conclusions] The effect of the recommendation of a minimum withdrawal time of 6 min was limited, and the PDR did not improve. To improve the colonoscopy quality, different measures, such as careful observation techniques, longer withdrawal time (up to 10 min), and feedback to endoscopists, should be implemented.