Which is better, "barium" or "gastric camera" for stomach examination?Explain the advantages / disadvantages

Is barium testing obsolete?

In the company's regular health examination, "barium examination (stomach X-ray examination)" is often performed as a diagnosis for gastric cancer. However, "gastric camera (gastric endoscopy)" is sometimes recommended for gastric examination, and it seems that some people are wondering which is better. Some people have pointed out that the barium test is "less accurate than the gastrocamera," "obsolete," and "not done in foreign countries." [Table] What are the advantages / disadvantages of "barium examination" and "gastric camera examination"? How is it actually? I asked Madoka Mori, a medical journalist.

Barium test that can observe the entire stomach

Q. Please tell me the outline, advantages and disadvantages of barium inspection. Mr. Mori "The barium test is a test in which you drink barium (contrast medium) and see through the stomach with X-rays to examine the shape of the stomach, the condition and changes of the mucous membrane. The strength is that you can observe the entire image of the stomach at once. It can be said that it is also an advantage that the examination cost can be reduced compared to endoscopy and that there are many facilities that carry out examinations. It can be said that it is not suitable for this. Also, because it is an examination using X-rays, it is considered that there is a disadvantage that there is a small amount of radiation exposure (it is said that there is no concern that it will affect the human body). However, after the test, barium hardens in the stomach and constipation is likely to occur, so it is necessary to take a laxative, which is a burden for some people. If any abnormality is found, an endoscopy is performed. There is also the idea that it is necessary and less efficient than choosing endoscopic examination from the beginning. ”Q. What are the outlines, advantages, and disadvantages of gastrocamera examination? Mr. Mori "This is an examination in which a thin tube with a camera is inserted through the mouth or nose and the unevenness, changes, and color tone of the surface of the stomach are directly observed on a monitor. Another advantage is that if necessary, a part of the tissue in the suspected abnormality can be collected during the examination, examined by pathological examination, and a definitive diagnosis can be made. The disadvantages are that it requires throat anesthesia, the examination time is longer, the number of facilities is smaller, and the cost is higher than the X-ray examination. Also, the tube of the endoscope passes through the throat. Many people feel pain when they inflate their stomach during an examination, and such a burden can be considered a disadvantage. ”Q.“ Barium examination is less accurate than a gastrocamera ”“ Obsolete ”“ Do it in foreign countries It seems that some people have pointed out that it is not, but is it true? Mr. Mori "There is certainly such a point because the amount of information that can be obtained from the barium test is limited compared to the gastrocamera test. According to the" Community Health and Health Promotion Business Report "published annually by the Ministry of Health, Labor and Welfare, In 2014, when the only "stomach cancer screening" recommended by the government was barium testing, of the 2,234,312 people who underwent gastric cancer screening, 175,141 (about 7.5%) were judged to require a detailed examination. ), Of the 139,237 people who actually underwent a gastrocamera examination, 2,237 had stomach cancer, about 0.1% of those who underwent cancer screening and about 1.6% of those who underwent a detailed examination. I can't say it unconditionally, but looking at this number, the barium test is not efficient as a screening test, and it may be considered "obsolete". Although it is an old document, the 2007 Ministry of Health, Labor and Welfare's "Survey Results on Cancer Screening Systems in Other Countries" shows the differences from other countries. When I referred to the government departments in Canada, the Netherlands, Sweden, and Finland, no country had a test equivalent to Japan's "stomach cancer screening," and the gastric X-ray test (barium test) as a screening test was unique to Japan. On the other hand, a doctor of gastrointestinal surgery at a cancer specialty hospital, who I interviewed earlier, said, "It spreads into the wall of the stomach and appears on the surface of the mucous membrane of the stomach. There are cases where it is difficult to diagnose "skills gastric cancer" by endoscopy, and in some cases it can be found by barium examination. "Q. Why is the barium examination, which is said to be" outdated ", still? Is it widely used? Mr. Mori "In the" cancer screening "recommended by the national government as a cancer control and conducted by the municipalities as a business, gastric cancer screening has been a long-standing guideline," gastric X-ray examination (40 years old and over, once a year) ". From April 2016, "Gastroscopy (50 years old and over, once every two years)" was added, and the content was changed to select either one, but all over the country. The medical environment is not always compatible with the introduction of endoscopy. Since the gastric X-ray examination (barium examination) is also performed on the "examination vehicle (patrol type bus)", it is possible to receive a medical examination. It is still widely used because of its easy access and low cost. Municipalities follow the national guidelines to proceed with "cancer screening", so while it is indicated in the guidelines, I think the current situation will continue. Also, even if there are multiple facilities and medical institutions that perform endoscopy in urban areas, the number of people who can perform endoscopy as a gastric cancer screening in one day. Because of the fact that it is difficult to make a reservation because of the limited number of patients, it seems that many people choose the barium test. "

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