微小胃癌における通常内視鏡診断の限界に迫る

How Can We Diagnose a Minute Gastric Cancer by Conventional White Light Endoscopy?

要旨　当院で術前に指摘し，内視鏡的切除術を施行した微小胃癌118例の発見契機，内視鏡所見について，肉眼型別・組織型別に検討した．発見契機は，隆起型微小胃癌では隆起，陥凹型微小胃癌では組織型にかかわらず色調の変化が最も多かった．内視鏡的特徴は，隆起型病変では発赤調の表面平滑で不整形な隆起，分化型陥凹型病変では，発赤した境界明瞭な不整形陥凹で辺縁隆起を伴うもの，未分化型病変は色調の変化を伴う領域または小陥凹であった．微小胃癌の発見には，胃内の丁寧な洗浄と観察に加え，色素観察によりわずかな変化をとらえることが重要である．

　The detection trigger and endoscopic findings with conventional white-light endoscopy of 118 MGC〔minute gastric cancers（5mm or less in diameter）〕were evaluated according to macroscopic and histologic types. The detection trigger was elevation for elevated type MGC, and change of color for depressed type MGC. Endoscopic findings for MGC were : smooth irregular elevation for elevated lesions, reddish well-demarcated irregular depression with surrounding elevation for differentiated type depressed lesions, and small area or depression with discoloration for undifferentiated type depressed lesions. To detect a MGC by conventional white light endoscopy, it is essential to rinse the stomach and pay attention to minute changes of the mucosa in addition to chromoendoscopy.