胃癌スクリーニングにおけるpanendoscopyの有用性―特にX線検査と対比して

The Superiority of Panendoscopy as the Screening Method of Gastric Cancer; A Comparison with Fluoroscopy

要旨　外来患者の上部消化管疾患のスクリーニングにX線を用いた4,568名の成績と，panendoscopyを用いた5,043名の成績を比較検討した．上部消化管スクリーニングにおいてX線検査およびpanendoscopyの胃癌発見率はそれぞれ1.51，1.49％と同様であったが，発見胃癌に占める早期癌の比率は前者で14.5％，後者では45.3％と3倍も高かった．これは早期胃癌の発見にはpanendoscopyがX線検査より優れていることを示す．次に，X線検査で発見した早期胃癌の最大径の平均値は41.3mm，panendoscopyのそれは26.9mm，20mm以下の小病巣の頻度は前者では14.3％，後者で50.0％，更に10mm以下の小癌および微小癌はそれぞれ10.7，26.5％であった．早期胃癌でもより早期の，より微小のものを発見すべきことを強調した．病巣が無茎性の隆起型でも，陥凹型でも十分に小さければ，内視鏡的ポリペクトミーにより治癒せしめうるからである．

　The author investigated the results of screening examinations of the upper gastrointestinal tract by x-ray fluoroscopy on 4,568 outpatients and by endoscopy with a thin forward-viewing panendoscopy on 5,043 outpatients of his clinic to determine which should be the method of choice.

　No significant difference was observed in the discovering rate of gastric cancer: 1.51％ by fluoroscopy and 1.49％ by endoscopy. But early cancer ratio to the whole number of gastric cancers were 14.5％ and 45.3％, respectively, which suggests that endoscopy is superior to fluoroscopy in the ability of discovering gastric cancers in their early stage (p＜0.05).

　Next, the morphological characteristics were compared between early gastric cancers detected by fluoroscopy and those by endoscopy. The average size of the former lesions was 41.3 mm in diameter, while the latter 26.9 mm. And the frequency of small lesions less than 20 mm among the whole lesions was, the former, 14.3％, the latter 50.0％.

　Furthermore, the author emphasized that endoscopists should make every effort to find earlier and smaller gastric cancers, because they can be cured perfectly by the endoscopic polypectomy technique. No surgery is needed for a small cancer.