内視鏡による胃内への造影剤散布法（Barium-Spray Method）の考案

Study on Barium-Spray Method by Gastroscope

　胃病変の診断はX線学的には，二重造影法，内視鏡的には，ライトガイドファイバースコープの開発普及により著るしく向上した．また，内視鏡における色素剤散布法の開発により，内視鏡診断上の欠点とされていた粘膜の凹凸の変化が，よく観察できるようになった．これらの検査法は，いずれも多くの利点を有しているが，その反面，その操作上，かなりのコツを要し，また，両検査を同じ日に行なえないために，診断上必要な両所見の対比が，困難なことが少なくないという欠点もある．そこで，われわれはX線と内視鏡検査を同時に行ない，しかも，二重造影法と色素剤散布法の利点を併せもち，患者の肉体的負担が少ない簡便な検査法として，内視鏡による造影剤散布法（Barium-Spray Method）を考案してみた．さきに，内視鏡を用いないX線透視下での導管による造影剤を散布する方法については，1962年放射線学会関東地方会で発表して以来，その簡便性，正確性について基礎的研究を続けていたが，今回，単純な導管挿入に代わるものとして，内視鏡を応用することを考えた．この目的には，生検用および細胞診用の内視鏡であれば，すべて応用できる．この検査法は，内視鏡を利用して直視下で，造影剤を病変部へ選択的に散布し，胃X線検査および内視鏡検査を同時に行なえる点で，従来の検査法に比べて，一段と有利であると考える．

　This report concerns with a study on barium spray method, a new radiological and endoscopic examination of gastric diseases that conbines the merits of both double contrast method in x-ray and dye spreading method in endoscopy. Forty five cases with gastric diseases were examined in this study.

　Method: After routine endoscopic examination with a gastroscope (Type B or C) contrast medium (barium) is sprayed directly over a lesion through a vynyl tube introduced within the gastroscope. The gastric mucosa, with its red making a strong contrast with the white of barium, is then examined endoscopically, with x-ray photographs taken at the same time.

　Merits: 1) Endoscopic and radiological examinations can be made at the same time and both findings can be compared with each other. 2) The volume of contrast medium and air can be each controlled through the instrument under direct observation with gastroscope. 3) Endoscopically, details of a gastric lesion, especially those concaved and protruding changes hard to distinguish by a common endoscopy, can be seen to a better advantage because of the gastric mucosa highly accentuated against the white of contrast medium. 4) Radiologically, lesions on the anterior wall and in the upper parts of the stmach not so well studied even by double contrast method can easily be examined without any positional change of the patient. Barium spray method, giving us many characteristic findings both in the endoscopical and radiologic photographs, is believed to be a valuable examination procedure for the diagnosis of gastric diseases.