色素による内視鏡検査法―慢性胃炎を中心に

Gastroscopy with Application of Dyes to Chronic Gastritis

　慢性胃炎の的確な内視鏡診断はきわめてむずかしいとするのが，かつて一般的な考え方であり，これに従事する研究者が等しく悩まされてきた大きな問題であった．しかし，早期胃癌，なかでも微小Ⅱbの発見はこの慢性胃炎の正確な診断の上に可能となるであろうと考えられるにおよび，この病変に対する関心は再び熱気を帯びた感があり，最近多方面からの研究が積み重ねられた．なかでも特筆できることは胃生検所見を基盤とした内視鏡所見の再評価と，色素を応用した内視鏡検査法の展開であろう．

　ここでは後者の方法として主としてコンゴーロート法，色素撒布法，色素着色法を中心に述べ，さらにこれらの基礎となる切除胃での色素染色法にもふれてみたい．

　Endoscopy of the stomach was first supplemented for better diagnosis by the use of dye scattering method, followd by exploitation of Congo red method used also as a functional test of the gastric mucosa, and now diagnosis of gastric lesions has made a tremendous progress by the use of recent endoscopic dyeing method. In this paper is made a brief survey of the techniques of the former two procedures, followed by a more detailed description of endoscopic dyeing method. Finally staining the surgical specimens with dyes is introduced that forms the basis of dyeing gastroscopy.

　Dye methods for the diagnosis of chronic gastritis have each merits and demerits, and one should apply them to the diagnosis after knowing well the characteristics of each procedure. Namely, dye scattering method is a procedure to know the degree and extent of gastric lesion by scattering non-absorbent dyes such as indigo-carmine or Evans blue that make the surface unevenness more prominent.

　Congo red method aims at observing the excretory area of gastric acid by utilizing its nature to change its color in acid

　Dyeing method employs absorbent dyes such as methylene blue or truidine blue that are absorbed by the area of intestinal metaplasia of the gastric mucosa, showing it as a dyed area. Accordingly, the existence or distribution of intestinal metaplasia in the gastric mucosa, hitherto difficult to observe by the usual endoscopy, is now confirmed with relative ease.

It should be noted, however, that in applying these dyes to the diagnosis of gastric lesion, one must be fully versed in the morphology of the mucosal surface of the stomach in resected specimens. For this purpose,Alcianblue-Hematoxyline staining of the specimens is most satisfactory.