経口胆道鏡による胆道癌の診断

Endoscopic Study of Bilialy Carcinoma by Peroral Cholangioscopy

要旨　黄疸のない胆管癌9例と胆嚢癌の総胆管浸潤2例に親子スコープ方式でPOCSを行った．子スコープ挿入に際してはEST後に行ったが，EST困難例にはガイド・カテーテル内を通して細径胆管鏡を挿入し観察した．11例中9例で挿入に成功し，観察が可能であった．生検診断または擦過細胞診を併用することで確診しえた．また，胆嚢癌の胆管浸潤例では全体に蒼白調であり，辺縁に細血管の拡張があり，胆管癌と鑑別は可能であった．胆管癌では隆起を呈した症例は黄色調か同色調で，周囲の粘膜に凹凸性変化が認められた．狭窄性病変では周囲粘膜と同色調で辺縁に細血管の拡張を伴っていた．ERCで胆道系に何らかの所見が認められたときは，ガイド・カテーテルを用いたPOCSを行い，胆管癌の可能性が少しでもあるときはESTを行ってPOCS下に確実な生検を行うことで，早期の胆管癌の確定診断が得られるものと考えている．

　Peroral cholangioscopy (POCS) was performed in 11 cases with biliary tract carcinoma. There were nine cases of bile duct carcinoma and two cases of gallbladder carcinoma. No dilatation of the intrahepatic duct was seen in any of the cases. Baby scopes (CHF-B20, XCHF-B34, or XPF-14 long, OLYMPUS) and mother scopes (TJF-M20, TJF-20, or JF-1T30) were employed for these purposes.

　Successful observation of the carcinoma was attained in nine cases (81%). Diagnosis was made by biopsy and cytology. Endoscopic findings showed that three cases of bile duct carcinoma were yellowish and another four cases were the same color as normal mucosa. Invasion from gallbladder carcinoma was pale in two cases. Three cases of bile duct carcinoma had elevated lesions and rough-surfaced mucosa. In two bile duct carcinomas and two gallbladder carcinomas there was stricture of the common bile duct, and dilated vascular pattern.

　In conclusion, if abnormal findings of ERC are recognized, we recommend POCS using a guide-catheter. Moreover, if there is a suspicion of carcinoma, we recommend performing endoscopic sphincterotomy and taking a biopsy specimen under endoscopic control.