十二指腸潰瘍の診断とその問題点―内視鏡診断を中心に

Diagnosis of Duodenal Ulcer and its Problems: Concerning on endoscopic diagnosis

　1961年Hirschowitzによるファイバースコープを用いた胃および十二指腸球部の内視鏡検査についての報告以来，十二指腸粘膜を内視鏡的に観察，撮影しようとする試みが，欧米のみならず本邦においても多くの研究者により報告されてきた．教室の田中らが球部撮影用に長くした胃カメラを用いて，初めて十二指腸潰瘍の撮影に成功したのは1962年であった．

　以来，わが国においては，オリンパス光学および町田製作所で十二指腸ファイバーの開発が進められ，現在ではほぼ満足すべきファイバースコープが完成され，内視鏡検査手技についても，多くの研究者の努力により，安全かつ容易に検査を行ない得ることが判り，膵，胆道疾患へのアプローチと同時に，十二指腸疾患の診断上，十二指腸内視鏡検査は不可欠なものとなってきた．

　The results of endoscopic diagnosis in 448 cases including those already confirmed as duodenal ulcer by roentgenography, those in which no definite change was noticed at least in the bulb and those in which emergency endoscopy was performed on account of hematemesis or melena, are as follows:－

　1. Diagnosis with endoscopy mostly of the bulb was successful in 98.5 per cent.

　2. It is now evident that in the diagnosis of duodenal ulcer especially in ascertaining its stage, endoscopy is a procedure that can fully supplement roentgenological diagnosis.

　3. Each characteristics of forward-viewing and side-viewing fiberscopes must be fully grasped for their proper use depending on cases to be examined. It has been keenly felt that this attitude would greatly aid the endoscopic diagnosis of the lesions in the bulb.

　4. Forward-viewing fiberscope (GIF) was effectively employed in cases of active bleeding from the upper digestive tract and cases not to be examined roentgenologically. The same was true in bleeding duodenal ulcer.

　5. Various stages of progress in duodenal ulcer have been divided into four on the basis of endoscopic findings: acute, chronic and healing stages and ulcerscar. Linear ulcer was intractable.

　Problems waiting solution in future.

　1. The duodenofiberscope currently employed has still blind areas within the duodenum, so that endoscopy of the bulb cannot dispense with the help of x-ray. Further technical and mechanical improvements are essential to perfect endoscopic procedures in the examination of the bulb.

　2. In some cases linear ulcer was difficult to differentiate from multiple ulcers, nor was it easy to do so from line-like ulcer developing during the healing stage of solitary huge ulcer.

　3. Concerning to the problems, whether salami-state of the mucosa and irregular shaped ulcer are characteristic only in the duodenum, further study will be eagerly awaited.

　4. Endoscopic criteria of healing in duodenal ulcer are commonly based on the disappearance of white coat over the lesion, but some cases show marked reddening over the ulcer scar. At times thin white coat is difficult to discriminate from discolored mucosal surface. Reevaluation of endoscopic pictures is desirable substantiated with histologic evidence.