Barrett食道のX線診断

Radiological Diagnosis of Barrett's Esophagus

要旨　Barrett食道のX線診断はその特徴的な所見が十分に検討されていない面もあり，内視鏡診断にその大部分を委ねてきたと言えよう．本稿においては内視鏡検査によりBarrett食道と診断された3例と単なる逆流性食道炎1例およびBarrett上皮より発生したと判定された食道腺癌症例3例のX線像を供覧し検討した．少数例の検討であり結論的な所見を提示することはできない．食道裂孔ヘルニアと食道潰瘍またその瘢痕による狭窄像を有する症例においてはBarrett上皮の存在する可能性が高く，その粘膜面は粗ぞう像を呈し，縦走する淡いバリウム模様を示す食道炎症例とは鑑別しうる症例が存在した．腺癌においてはその占拠部位，食道胃接合部との位置関係，潰瘍形成像の目立たない陰影欠損像などとこれに接する粘膜面の不整像は診断の手掛かりは得られるが，表層伸展像との鑑別が困難であった．

　Radiological diagnosis of Barrett's esophagus has not been fully pursued, thus leaving endoscopic examination as a main diagnostic modality.

　We present here radiological findings obtained in 3 cases of Barrett's esophagus confirmed endoscopically, a case of simple reflux esophagitis and 3 cases of esophageal adenocarcinoma considered to have originated from Barrett's epithelium. The number of cases was too small to derive any conclusive findings. The cases of esophageal hiatus hernia, esophageal ulcer or ulcer scar were likely to have Barrett's epithelium. Some of these lesions were differentiated from esophagitis based on the findings of rough mucosa and longitudinal faint barium pattern. Although adenocarcinoma might present with such diagnostic clues as the location of the lesion, relation to the esophagogastric junction, non-salient shadow defect of ulcer formation bordered with rough mucosa, it was difficult to differentiate it from superficial extension.