大腸の炎症性疾患の診断に注腸X線検査は必要か―内視鏡を重視する立場から

Comparison of Endoscopy and Barium Enema Study in Detecting Colorectal Cancer or Dysplasia Associated with Long-standing Ulcerative Colitis

要旨　潰瘍性大腸炎長期経過例に合併してくる癌・dysplasia病変の存在診断について，内視鏡検査と注腸検査の比較を行った．(1)有症状群における検討：炎症症状を有する症例では，バリウムの付着が不良で病変の描出が困難であった．狭窄を有する症例では内視鏡診断が困難で，生検組織の採取も不十分であるのに比べ，注腸検査では狭窄部の不規則性・非対称性の所見から悪性の診断が可能であった．(2)サーベイランス群における検討：潰瘍の目立つ症例やDALMと称される隆起性病変の検出においては，両検査の診断能はほぼ同等であった．極めて丈の低い隆起から成るdysplasiaの診断においては，内視鏡検査のほうが優れていた．以上から，癌・dysplasiaをより早期の段階で発見するためには，内視鏡検査が注腸検査よりも優れていると考えられた．

　The diagnostic accuracy of endoscopy and barium enema study in detecting colorectal cancer or dysplasia associated with longstanding ulcerative colitis was studied retrospectively. (1) Symptomatic cases: In cases with active inflammation, even a polypoid mass could not be delineated by contrast medium because of insufficient preparation and abundant mucus. On the other hand, while endoscopic diagnosis was difficult in cases with colonic stricture, irregular and asymmetrical stricture shown by barium enema study was pathognomonic of malignancy. (2) Non-symptomatic cases (Cases revealed during colonoscopic surveillance programs): Among cases with ulcerative lesions or DALM (dysplasia associated lesion or mass), neoplastic lesions were identified almost equally by both methods. However, slightly flat-elevated lesions could be detected only by endoscopy. These results suggested that endoscopy is superior to barium enema study in detecting colorectal cancer or dysplasia at an early phase in non-symptomatic patients with longstanding ulcerative colitis.