集検におけるヨード染色法の有用性―特に食道ｍ癌の発見を目的として

Lugol Staining for Detection of Early Esophageal Cancer: Clinical Effectiveness of the Lugol Staining Method in Mass-screening Examination, Especially for Detection of Mucosal Cancer of the Esophagus

要旨　食道m癌発見のためのヨード染色の有用性と集検への応用について，次のような結果を得た．①食道m癌の発見を増加させるためには，健康人を対象とし，細径パンエンドスコープ受診人口の増加，内視鏡継続検診者（隔年）の増加，50歳以上男性に対するヨード染色のルーチン化などをシステム化することで，食道表在癌90％，食道m癌60％以上の成績が得られるようになった．②固定集団の施設逐年集検で，隔年細径パンエンドスコープと毎年X線TVのいずれかを選択させることにより，それぞれの群にほぼ50％ずつの希望受診者があったが，5,000人の対象者の15年間の継続検診から11例の食道癌が発見され，そのうち食道m癌4例はすべて隔年内視鏡検診群から発見され，50歳以上の男性に対するヨード染色の併用が非常に効果的であった．

　For establishment of examination system for detection of mucosal cancer of the esophagus, clinical effectiveness of the lugol staining method was evaluated, and the lugol staining method has been applied to mass-screening examination for esophageal cancer. The results were summarized as follows. 1) For 15 years between August 1978 and March 1993, we found 62 cases of mucosal cancer of the esophagus. To detect mucosal esophageal cancer, male older than 50-year-old without symptoms should be regarded as a high risk group and should be screened by small-diameter panendoscopic examination with lugol staining. Bi-annual screening endoscopic upper gastrointestinal (GI) examination might increase the detection rate of mucosal esophageal cancer: More than 60% of the esophageal cancers which were about 20 cases per year on average detected within the last three years was mucosal cancer. 2) The following healthy examinees have been screened by upper GI examinations successively for 15 years: number of examinees was 5,000, 90% of them was male, 85% of them was age between 40 and 50 year-old. Examinees were asked to choose either biannual upper GI endoscopic examination or annual upper GI barium swallow examination. Almost the same number of examinees choose either examination. There were 11 cases of esophageal cancer found as a total: four cases of mucosal cancer (including two cases of epithelial cancer), four cases of submucosal cancer and three cases of advanced as musularis propria or more invasive cancer. In the bi-annually screened by panendoscopic examination group, four mucosal cancers and two submucosal cancers were detected. Therefore, endoscopic examination with lugol staining applied to male older than 50-year-old are effective to detect esophageal cancer. One epithelial cancer which was one of the four mucosal cancers detected by screening biannual endoscopic examination was successfully removed by endoscopic mucosal resection.