早期胃癌の内視鏡診断過程の実態

The Present Status of the Process of Endoscopic Diagnosis of Early Gastric Cancer

　かつて，早期胃癌の1例，1例を診断するたびに体験できた，背筋のゾクゾクするような喜びと緊張感は，どうも最近の若い医師には感じられないようであり，年輩者にもそういう気持が少なくなってきた．早期胃癌が診断できて，ごくあたりまえになってきた．早期胃癌診断学の標準化時代と言えるのであろう．

　いまでは，微小胃癌やⅡbの診断に，この病変はもしかするとという胸の躍るような気持を押さえきれないのは，われわれの問題意識がここに集中してしまっているためであろうか．しかし，早期胃癌の診断そのものが，実際に容易になったかと言えば，必ずしもそうではないし，生検の助けがなければ，内視鏡診断そのものは，以前よりずいぶん粗雑になっているのではなかろうか．早期胃癌研究会の症例検討でも，私自身が味わっている実感である．

　The problems involved in the process of endoscopic diagnosis of early gastric cancer and its present situation were studied based on our experiences.

　Today, the diagnosis of early gastric cancer has become universal and is easily conducted in hospitals and clinics. Particularly, due to the development of the endoscope apparatus, examinations by endoscopy are given priority during stages of screening for cancer. It is thought that it will give new directions in the detection of early gastric cancer. However recently, gastric biopsy is apt to be done too easily and endoscopic examinations are neglected. It is preferable that biopsy is conducted after a correct diagnosis is made by making full use of the endoscope and its method of examination.

　There are cases wherein the ordinary means of examination with the use of the endoscope is difficult because of the degree of invasion and the size of the lesion. Supplementary methods of diagnosis such as the dyeing method should also be put to use.

　The early gastric cancer type IIb and minute gastric cancer come closest to the primary type of lesion and are those which are given a lot attention, but it is extremely difficult to diagnose them even by using the endoscopic diagnostic method to its fullest capability. It seems that the application of laser endoscopy should be given thought.