臨床の場における上部消化管スクリーニング法―内視鏡の立場より

Screening of the Upper Gastrointestinal Tract Diseases in Practice: From the viewpoint of endoscopic examination

　X線と内視鏡のどちらを臨床のスクリーニングの場で優先させるべきであるかの評価を正しく比較検討するには多くのfactorを考慮しなければならず，安易にその結論は決められない．日常，上部消化管疾患の診断には両検査の協同作業下に拾い上げから確診までが行われ，相互の情報を総合的に利用するのが現況であり，スクリーニング法としてはケース・バイ・ケースで選択されている．

　実際に経験された多数の小病変についてretrospectiveにみると両検査とも“そこに病変がある”と指摘された場合には，その描出はほとんど可能であり，また，X線フィルム，内視鏡フィルムの再読影でもチェックできるものが大部分である．

　We analysed a diagnostic value of both x-ray and endoscopic examinations done at an interval between a few days as a screening tool to detect upper gastrointestinal diseases. We reviewed 1,222 cases for this study. Each one case of 60 cases with advanced gastric cancer was misdiagnosed by both initial x-ray and endoscopic examinations, respectively. Sixteen cases of early gastric cancer were also misdiagnosed by initial x-ray examination. X-ray diagnosis of these sixteen cases was as follows; two of gastric polyp, five of gastritis, three of gastric ulcer and gastric ulcer scar, and one of duodenal ulcer. In each one diagnosed as gastric polyp and duodenal ulcer it was impossible to pick up any lesion of cancer even by repeated x-ray examination. These two cases were Ⅱb like minute cancer and red spot was the only endoscopic finding by examination. As mentioned above, cases in which the lesion of cancer was missed by initial x-ray examination were very few. Therefore, when x-ray examination was performed under “good” condition and capability to read x-ray film was sufficient, x-ray examination is an excellent screening tool to detect gastrointestinal diseases. Superiority of endoscopic and x-ray examination as a screening tool has been discussed.