胃・十二指腸隆起性病変の生検

Biopsical Diagnosis of Protruding Lesion of the Stomach and Duodenum

　診断法の進歩により，現在では，Ⅲ型早期胃癌の診断およびⅡb型早期胃癌へのapproachを除き，早期胃癌の診断基準は，ほぼ確立された観さえある．この進歩には．内視鏡の発達と歴史を共にして発展してきた直視下胃生検法のあずかるところも大きい．

　1964年，常岡，竹本，春日井ら¹⁾により，その優秀性が報告され，最近では胃内全域がほとんど盲点なく生検できる検査法にまで進歩し，すでにroutine化されている．

　Some of the present-day problems of gastric biopsy have been discussed on the basis of illustrative cases encountered in our Department.

　Direct vision biopsy has now become one of the routine diagnostic procedures in gastric lesion. Technically it has few problems, and lesions in the duodenum and even small intestine belong to the domain of direct vision biopsy. As for cancer lesions of the stomach, Biopsical diagnosis to type Ⅰ or Ⅱa early cancer now boasts of far better positive results, at times nearing 100 per cent, as compared with lesions showing limited lateral spread within the mucosa such as early cancer of type Ⅲ, Ⅲ+Ⅱc or advanced Borrmann type Ⅱ cancer. Considered as a whole, diagnostic procedures of early cancer of the stomach are definitely established, but qualitative diagnosis of small protruding lesion is as yet fairly difficult. Whether it be benign or malignant can only be determined by biopsy. For all that, it is still almost of no avail in the diagnosis of non-epithelial tumor such as submucosal one. This is an important problem to be tackled in future.