胃がんハイリスクストラテジーにもとづく胃内視鏡検診

DOI 被引用文献12件 参考文献55件
  • 三木 一正
    東邦大学医学部医学科内科学講座(大森)消化器内科

書誌事項

タイトル別名
  • ENDOSCOPIC STOMACH CANCER SCREENING BASED ON THE HIGH RISK STRATEGY

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We have previously conducted a study on the accuracy of the pepsinogen (PG) method and its effectiveness in reducing the mortality rate of stomach cancer. We have developed and proposed the stomach cancer screening system which is an economically feasible management method for bringing about a reduction in stomach cancer mortality rates by adopting a high risk strategy for stomach cancer screening after conducting a comprehensive economic evaluation as a countermeasure for stomach cancer on the basis of previous research findings. Method and Results ; (1) The effectiveness of reducing stomach cancer mortality rates using the PG method alone was confirmed using an observation technique in the form of a case -control study (retrospectively over the course of 13 years) based on data obtained from areas implementing stomach cancer examinations using the PG method. (2) The accuracy of the PG method was demonstrated to be nearly equal to that of X-rays (digital radiography, DR) and examinations combining the PG and X-ray methods were found to be both feasible and useful in a study of the accuracy and cost effectiveness of the PG and X-ray methods by conducting stomach cancer examinations combining the PG method and X-ray method (DR). (3) In a study of the annual incidence of stomach cancer and hazard ratio in stomach cancer examinations combining assay of Hp antibody levels and the PG method (follow-up study on healthy males over a period of 10 years), stomach cancer was observed to not have occurred for 10 years in a group free of infection by H pylori (Group A : Hp O, PG O), this Group A was designated as a low risk group and excluded from stomach cancer examinations, and stomach cancer examinations consisting of selective screening for groups complicated with atrophic gastritis (Groups B, C and D) were demonstrated to be feasible. In addition, the optimum examination intervals for each of Group B (Hp (+), PG (-)), Group C (Hp (+), PG (+)) and Group D (Hp (-), PG (+)) (namely, the risk for stomach cancer) was determined to be suitable at the rate of once every 5 years for Group A, once every 3 years for Group B, once every 2 years for Group C, and once a year for Group D. In the future, it is strongly hoped that the efficiency of stomach cancer examinations will be improved and that stomach cancer examinations that are economical while also bringing about a reduction in the stomach cancer mortality rate will be realized by promoting and proliferating stomach cancer examinations combining assay of Hp antibody levels and the PG method as described above on a national scale. In conclusion, the use of assay of Hp antibody levels and the PG method for primary screening and the use of endoscopic examinations (small diameter and transnasal) for secondary screening is considered to be the recommended approach for stomach cancer examinations as countermeasures against stomach cancer.

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