X線と内視鏡との協力―十二指腸

Mutual Supplemental Role of Radiography and Endoscopy in the Diagnosis of the Duodenal Diseases

　古来，X線検査と内視鏡検査は表裏一体の検査法といわれ，両者の所見を比較検討することによって，その診断法は進歩確立されてきた．

　十二指腸小腸病変のうち，X線内視鏡両検査法がその診断に最も寄与できる疾患は，管腔内病変であろう．そこで今回は十二指腸の管腔内病変のうち2，3の代表疾患について，その診断能とその限界を検討し，臨床的にどのようにかみ合って両検査がなされるべきかについて述べたい．

　Diagnosability in radiography and endoscopy was studied from the clinical view in the representative duodenal disease.

　1) Duodenal ulcer: Diagnosability was almost equal in the determination of the stage of the ulcer. However the correct determination could not be made in the cases in whom compression study, insertion of fiberscope and endoscopic observation could not be done. Therefore we thought it necessary to supply each other's defect in such cases. In addition we think it important to try to compare radiographic and endoscopic findings in daily practice in order to read correctly the shape, number and stage of the ulcer on X-ray films.

　2) Papillary cancer of the duodenum: Correct diagnosis was relatively easy in both of the examinations in the studied cases more than eleven millimeters in diameter. Endoscopy including biopsy and ERCP was the essential diagnostic measure. X-ray examination was also indispensable in some cases for the differentiation from pancreatitis and pancreatic cancer.

　3) Minute lesions of the duodenum: Duodenal lesion of the familial adenomatosis coli syndrome and orifice of the choledochoduodenal fistula were studied as the representative of elevated and depressed lesions. Diagnostic extent in radiography was considered about three millimeters in diameter. However smaller lesions were also diagnosable after repeated comparative study of radiographic and endoscopic findings.

　From these results we think it necessary to compare repeatedly radiographic and endoscopic findings for the progress of diagnosability in the both examinations.