金沢市における対策型胃内視鏡検診の現状

Current Status of Endoscopic Screening for Gastric Cancer in Kanazawa City by Kanazawa Medical Association

要旨●金沢市医師会では，2008年度より胃内視鏡検診を導入した．検診受診率・胃癌発見率は向上し，多数の食道癌も発見した．撮影画像は全例をダブルチェックし，一定条件下でレフリー判定も実施した（金沢市医師会方式）．画像評価により質的向上が得られ，生検の妥当性評価で生検の適正性・妥当性が向上した．プロセス指標を開示し検診機関の意識向上を図り，検診機関の平準化を目指した．機器の消毒，生検の条件などを要項で示し，安全性向上を目指した．また，偶発症報告を求めた．萎縮度判定を行いリスク検診の解析を行った．情報管理と読影処理能力向上を目指し，ICTを活用した検診システムの検討を開始した．対策型検診であり，精度管理と安全性は重要である．

　In Kanazawa city, since 2008, endoscopic examinations have been performed for screening of gastric cancer. This has led to an increase in the percentage of patients examined and in the early detection of gastric cancer. Moreover, many esophageal cancers have been detected using this method.

　It is very important to improve accuracy control and safety in population-based screening. In terms of accuracy control, all the obtained images were collected at the office of Kanazawa Medical Association and were examined by experienced endoscopy specialists. Triple checks（double check reading with referee check：the so-called Kanazawa Medical Association method）contributed to the quality control of this screening. The endoscopy specialists performing the reading evaluated the images and the validity of the biopsy. This method improved the quality of the images and the biopsy rate. We disclosed the process indices to increase the awareness among the examining doctors. For the safety, we indicated the sterilizing methods of the endoscopes and the conditions of biopsy. We also request a case report of any accidents that might have occurred.

　Using this screening system, the atrophic grade of gastric mucosa is evaluated for analysis of cancer risk. Discussions on the new system using ICT have been started as a means to improve its efficiency.