消化管出血の緊急内視鏡検査

Emergency Endoscopy for Bleeding in the Digestive Tract

　吐・下血を主訴とする上部消化管出血は日常よく遭遇するが，臨床家にとって迅速かつ，適切な処置が要求される症候群である．私達はこれまでも消化管出血をみた場合，早期内視鏡，または早期X線検査の意義を再三強調してきた^1)～8)．なかでも重症例においては患者の全身状態の回復に努める一方，緊急手術の適応決定のために，とくに“urgent endoscopy”(“emergency endoscopy”)として，同様に，またはむしろより積極的な内視鏡検査の意義を重視している．

　過去10年間に私達は上部消化管出血後，7日以内の内視鏡検査を214例に施行している(表1)が，これらを対象として内視鏡の立場から，消化管出血後の緊急内視鏡検査の意義と，その実際について述べてみる．

　For localization of bleeding sources in the upper gastrointestinal tract endoscopic examination can be performed with high enough diagnostic value in patients at any time when bleeding is of moderate degree. In patients with severe hemorrhage, belonging to the groups III and IV with circulatory insufficiency as devided by our classification, earliest possible establishment is required for determining the optimal time for examination or indication for immediate surgical intervention, despite various limitatioms imposed on emergency examination. In our opinion, emergency endoscopy for bleeding in the upper gastrointestinal tract, performed in severe cases as in the groups III and IV, should be defined as endoscopy for the bleeding sources in the upper GI tract done within 72 hours after the arrest of bleeding.

　Of about 300 patients with bleeding in the upper gastrointestinal tract encountered for the past ten years in our department, 156 underwent emergency endoscopy within 72 hours after cessation of hemorrhage. Twenty-one of them belonged to the group III, and 18, to IV. Emergency operation was required in 25 cases of these groups (64.1 per cent).

　Since various types of fiberscope have been developed in recent years, emergency endoscopy is now a safe and effective measure, rising more in importance with the development of upper GI endoscope. Bleeding from the upper gastrointestinal tract can now be diagnosed in any part of the esophagus, stomach or doudenum. It is especially a most effective measure for the diagnosis of bleeding lesions extending over two or more areas.

　Endoscopic treatment of bleeding sources is performed along with emergency endoscopy. Electrocoa-gulation can be utilized to arrest bleeding under direct view.