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消化管のなかでは,小腸は最も長いにもかかわらず,小腸疾患に対する診断学的アプローチは他の消化管のそれに比べて,著しく遅れていることは事実である1).小腸の形態学的診断法としては,従来から腹部単純X線検査に始まり,経口的造影剤投与によるX線検査,血管造影法,String-Testあるいは腸紐,盲目的小腸生検などがその中心としてなされてきたが,その成果は必ずしも十分とはいえなかった2).
近年小腸の内視鏡観察を日的に,経腹腸鏡の先駆的業績3)に続いて,小腸fiberscopeの開発がなされ,小腸疾患診断のための努力が報告されている4).
Up to date, several types of specific fiberscope for observing the small intestine have been made, for example, push type, rope way type and “sonde” type “Sonde” type of intestinal fiberscope, Olympus A-250, is 2850 mm in its length and 5.5 mm in diameter of its flexible portion, the tip of which has a leading plumb to guide a fiberscope. The fiberscope is given per os to the patient, and inserted to the small intestine through the esophagus and stomach. But the fiberscope is too small in its width to have a biopsy apparatus.
To 17 patients we applied this type intestinal fiberscope. In 14 cases (82.4%) of them, the descending part of the doudenum could be observed endoscopically. But the fiberscope reached to the jejunum in 7 cases (41.2%) and to the ileum in only 2 caces (11.8%). Namely, the fiberscope was so flexible and pliable that its loop was easily made in the stomach and it was also difficult to make the fiberscope pass the pyloric ring or the bent of the small intestine. In our trials, the mean time was 1 hour to the descending part of the duodenum, about 2 hours to the “Treitz”and 6 hours to the ileum.
During the endoscopic examination, the patient felt a pharyngeal pain or an alien feeling of the pharynx, but its degree was too mild.
Consequently, we cannot satisfy with the obtained insertion ratio of our trials, but in future with the advances of the insertion ratio resulting from the improvements of the fiberscope and its insertion method, we will be able to observe easily and completely the mucosal surface of the small intestine and to perform the endoscopic examination as the screening filter of morphological diseases of the small intestine.
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