食道噴門部癌の内視鏡診断

Endoscopic Diagnosis of Esophagocardial Cancer

　食道噴門部癌の診断には，接合部領域の小さい癌の診断から，開胸か開腹のみかという外科的治療の適応の決定まで，幅広いものを含んでいる．まずX線検査がなされるが，接合部領域の診断には特殊な工夫も試みられている．このことは内視鏡検査でも同じで，器種の選択，観察時の慣れなど，多少の努力が必要になってくる．ファイバースコープの改良と普及で，それほど特殊部位扱いされなくなってはいるものの，無神経では困る接合部領域の内視鏡診断である．

食道噴門部領域における内視鏡

　この領域の内視鏡検査には，食道ファイバースコープ，胃ファイバースコープの両者が従来より用いられ，その境界の領域ということで，両者より関心が向けられてきた．X線上，下部食道に癌の浸潤が考えられ，狭窄所見のある場合は，前方視の食道ファイバースコープの適応であり，接合部以下の病変を予想する場合は胃ファイバースコープでの検索が主体であった．しかし最近では，食道から十二指腸球部までを1本の内視鏡で観察する前方視のPan-endoscope（GIF，PFS）が普及し，食道や噴門は“上部消化管検査の際の通り路”という考えも盛り込まれて，噴門部領域もPan-endoscopeで観察される機会がふえている．

　The endoscopic examination of the esophagocardial cancer has two different roles. One is the early diagnosis of the cancer of the esophagocardia. And the other is the decision of the indication of the surgical procedure.“Open the chest”or“Only in the abdomen”is the important thing for the patient's course.

　For the examination of the esophagocardial region, the forward-view fiberscopes, such as the esophagofiberscope and the panendoscope, are advisable. Especially we have made some modifications for conventional EF-BⅡ (Olympus) for several years. The EF-BⅡ with 210 degrees' angle mechanism is the best instrument for the diagnosis of the esophagocardial region. From the oral side, the esophagogastric junction and the part of the junctional area as well as the lower esophagus is observed very easily and very clearly. In the next time the fiberscope is bent till 210 degrees at its top in the cardial area. The junctional area including the lower esophagus can be observed circumferentially from the stomach.

　The early cancer of the gastric cardia within 2 cm of distance away from the esophago-gastric junction has been encountered in only 18 cases in our hospital. Type Ⅱc of the early cancer has been experienced in many cases, but type Ⅱa of the small early cancer has been seen near the esophagogastric junction.

　This paper stressed the more frequent endoscopic examination for the screening test of the esophagocardial region to find out the early cancer of this area.