小腸の内視鏡―主として十二指腸内視鏡検査の現況について

INTESTINAL ENDOSCOPY

Ⅰ．緒言

　「小腸の内視鏡」というテーマをあたえられたとき，すでに胃内視鏡が十二指腸内にかなりの頻度に挿入可能となっていたし，あちこちで十二指腸専用のファイバースコープの試作が進められていた．この勢では，この原稿の締切頃にはきっと世界の誰かが空腸内挿入に成功するだろうと思っていた．それほどこの方面の研究は次第に白熱度を増してきているように思う．

　ファイバー光学系の応用によって，どうやら内視鏡は幽門輪というながい間挿入観察をはばんでいた関門を突破するに至った．そして十二指腸病変を内視鏡観察の対象とすることができるようになってきた．

　For endoscopic exploration of the duodenum, the gastroduodenal fiberscope originated by Hirshowitz in 1958 has then been utilized by many investigators, but until recently it has not been quite up to the mark. At all events, latest studies by Watson, MaCune, Takagi and the present writers have shown not only endoscopic observation of the duodenum and the Papilla of Vater, but also visualization by contrast medium of the pancreatic duct are now feasible in some instances.

　In this paper is reported the authors' attempts in this field. By means of one of the latest models of fiberscope, FGS-CL, the duodenum has been observed under pharyngeal anesthesia in 74 per cent of all patients examined. Duodenal ulcer is pointed out endoscopically in 50 cases. It is emphasized that 37 cases (74%) of them are confirmed as such by white exudate or scarring by inserting the fiberscope into the duodenum. Including the cases with white exudate obtained by transpyloric observation, 88 per cent of duodenal ulcer are strictly within reach of fiberscopic exploration. Endoscopy now plays a great role in the overall diagnosis of duodenal ulcer. It also is suggested by MaCune as well as by the present writers that visualization by contrast medium of the pancreatic duct and scheduled observation of the Papilla of Vater will soon be of great help in examination of the pancreas and the bile duct.

　On the other hand, limitations of fibergastroscope in the study of direct eye view of the duodenum and the small intestine are so deeply felt by all concerned that trial manufacture of newer fiberscopes, exclusive for the study of the duodeum, is now being energetically carried on.

　It is expected that very soon a day will come when duodenal fiberscope and furthermore intestinal fiberscope is available to all so that direct view observation of not merely the duodenum but also the small intestine can be as easily performed as examination of the stomach being done at present.