処置用ファイバースコープ（Gastrofiberscope for Treatment: T. G. F. Olympus）の使用経験―特に粘膜下病変の診断を中心に

Evaluation of Gastrofiberscope for Treatment (T. G. F. Proto-Type by OLYMPUS Co.)

　Gastrofiberscopeの歴史は未だ日が浅く，1957年HirschowitzらによりGastro-duodenal fiberscopeが初めて実用化されて以来，この分野での急速な進歩発展は目をみはらせるものがある．現在わが国においては直視下に病変を観察するにとどまらず，胃生検による組織診断への活躍あるいは薬剤の局所注射，というような治療面にまでその応用範囲は拡げられて来た．そして独り胃にとどまらず各種臓器に対して，また使用目的に応じて多数の器種が用いられている．ここに述べるGastrofiberscope for Treatment略してT. G. F.は1971年Olympus光学で開発され，その後改良を重ねられてきた．「胃内の処置を目的とした」試作品である．

　We have applied T. G. F. (Gastrofiberscope for Treatment proto-type, by OLYMPUS Co.) for the examination of the 103 cases of the stomach lesions. The most unique feature of this gastrofiberscope is the fact that the scope has two channels and the simultaneous use of two instruments is possible. Together with this gastrofiberscope, we have pick-up forceps for stabilizing the tissue, wire-snare, forceps for hemostasis, knife, scissors and other instruments to make transendoscopic surgery possible. Naturally, using two forceps are very multi-useful than one arm. We have experienced the using of T. G. F. on the following cases.

1) Polypectomy including sessile broad based flat polyp with electrocoagulation of the combination of pick-up forceps and the wire-snare.

2) Biopsy for the submucosal lesion.

　Even localised or diffuse submucosal lesion, for this procedure on both of them we used to graspes the surface of mucosa with pick-up forceps and cut it on its base with wire-snare applying hyfrequator.

3) Hemostasis of bleeding ulcer by electrocoagulation.

　This can be accomplished with the conventional method but the bleeding area is usually covered with fresh and old blood obscuring the exact location of hemorrhage. With the new T.G.F. scope, a small catheter is passed through one channel, an irrigating solution of either ice water or diluted adrenalin are used to control the hemorrhage so that the hemostatic forceps can be applied through channel 2 to the exact location.

4) Application of small clips.

　Furthermore, the special small clips can be applied to the exact bleeding location after electrocoagulation, this makes hemostasis surely. And also these clips may use for the suture of mucosa.

5) Removal of foreign body.

　After the gastrectomy, some patients react to the suture materials resulting in ulcerations. I was able to remove those sutures easily by a combination of pick-up forceps and scissors. Von Petz clips can also removed by electrocoagulation and a pick-up forceps.

　Although minor details can be refined further, introduction of this scope is smooth and easy. Electrical problems are non-existent if you ground the patient properly.