Objective: It has been reported that nasal breathing instead of mouth breathing during transnasal endoscopy reduces pharyngeal reflexes and improves tolerability of examinees. To determine whether recommendation of nasal breathing improves tumor detection rates, we compared the detection rates of esophageal browning, which is more frequent and widely used as a useful finding indicative of esophageal and pharyngeal cancer, between a control group not recommended nasal breathing and a group recommended such breathing. Subjects and Methods: We included 4,560 transnasal endoscopy examinations: 3,244 in the control group (2,042 males and 1,202 females, mean age: 54.7) and 1,316 in the nasal breathing group (821 males and 495 females, mean age 54.8) examined by the same three endoscopists using three endoscopes in both groups between 1 August 2020 and 31 January 2023. The brownish area was detected via image-enhanced endoscopic observation. Results: Up to 21 June 2022, 3,244 patients were examined without nasal breathing being recommended, and 52 people had a spotted brownish area (detection rate: 1.6%). On the other hand, after 21 June 2022, 1,316 patients were examined with nasal breathing being recommended, and 40 people had a brownish area (detection rate: 3.0%), showing a significant difference between the two groups. There was no significant difference in the frequency of discovering brownish areas between different endoscope models. Conclusion: Recommendation of nasal breathing in transnasal endoscopy is expected to contribute to the early detection of esophageal cancer with a high detection rate of a brown esophageal area.

Objective: This study aimed to investigate whether performing a detailed examination in a specialized pancreatic clinic (pancreas clinic) for cases of non-visualization of the pancreas (including poor visualization of the pancreas) and abnormal pancreatic findings (e.g., pancreatic cysts, main pancreatic duct dilatation, and pancreatic masses) identified on abdominal ultrasound (AUS) screening, and subsequent follow-up of these cases with pancreatic findings in the pancreas clinic, contributes to the identification of high-risk groups and the early detection of pancreatic cancer.

Subjects and Methods: This study targeted 34,066 cases that underwent AUS screening over a 3-year period beginning in January 2020 and compared the identification rate of pancreatic findings in cases that underwent a detailed examination before (pre-group) and after (post-group) the start of the pancreas clinic, each for a period of 18 months. All cases with pancreatic findings in the post-group were followed up at the pancreas clinic.

Results: At AUS screening, 4.9% of the cases had non-visualization of the pancreas, and 0.8% had abnormal pancreatic findings. For cases with non-visualization of the pancreas in the pre- and post-groups, 7.6% and 25%, respectively, had pancreatic findings after a detailed examination, with the post-group being significantly higher. For cases with pancreatic abnormal findings, the identification rate of pancreatic findings showed no significant difference between the pre- and post-groups. After the detailed examination, pancreatic cysts less than 5 mm were followed up in the pancreas clinic as a high-risk group for pancreatic cancer, and two cases of pancreatic cancer were detected at an early stage.

Conclusion: The identification rate of pancreatic findings increased by performing detailed examinations in the pancreas clinic for cases where the pancreas could not be visualized at AUS screening. By subsequently following up the high-risk group for pancreatic cancer identified based on detailed examination at the pancreas clinic, early diagnosis of pancreatic cancer can be expected.