色素内視鏡診断―内視鏡的に根治可能な早期胃癌の診断を考慮して

Endoscopic Diagnosis of Early Gastric Cancer Using Contrast Method: with special reference to detection of endoscopically curable lesions

要旨　早期胃癌の診断におけるコントラスト法の有用性を評価するため，スクリーニングの段階からコントラスト法を積極的に行っているわれわれの早期胃癌症例について検討した．長径20mm以下の病変が49.7％と多く，早期胃癌に占めるm癌の割合が71.6％と高かった．内視鏡的に根治可能な病変も16.3～22.6％含まれていた．コントラスト法による診断の内訳は，早期癌確診とその疑いが86.4％と多く，見逃しは3.6％にすぎなかった．通常内視鏡に比べてコントラスト法は，特に小病変の診断において格段に優れていた．内視鏡治療が可能になった現在，胃癌の診断目標は，早期胃癌の中でも，確実にリンパ節転移がないと言えるm癌に置くべきである．これには胃内に観察難点を持たないスコープ（筆者らは斜視型）を用い，そしてコントラスト法を応用した定期的な内視鏡検査が有効である．

　Usefulness of a contrast method which is routinely applied with our endoscopy in the diagnosis of early gastric cancer was studied. 49.7% of early cancers at our hospital were lesions under 20mm in size. 71.6% of early cancers had mucosal invasion. 86.4% of these early cancers were diagnosed correctly or as suspicious lesions. Only 3.6% of the lesions were overlooked. These results suggest that our contrast method was more useful in the detection of the smaller and earlier lesions than conventional endoscopy.

　After reviewing many reports of pathological studies on cases concerning resected early gastric cancer, it is clear that lesions without lymph node metastasis are as follows; mucosal cancer of I and Ⅱa type, within 20mm in size, and Ⅱc type within 10mm in size, and those lesions without ulcer or ulcer scar. It is possible to treat such lesions by therapeutic endoscopy. The conclusion is that we should aim at the detection of these early-stage cancers. For carrying out this aim, it is desirable to apply the contrast method from the first endoscopic examination.