スキルス胃癌の内視鏡診断

Endoscopic Diagnosis of Scirrhous Gastric Cancer

要旨●スキルス胃癌の典型的な内視鏡所見の特徴は伸展不良，ひだの変化，primary lesion（初期病変）の存在である．主に胃底腺領域に発生するLP（linitis plastica）型胃癌と，幽門腺領域に発生し幽門狭窄を呈するものに大別される．当院の4型胃癌143例の検討では，胃底腺領域型が83.2%と大半を占めた．最も多くみられた所見は伸展不良で，全体の96.5%で認めた．びらんや潰瘍などの上皮性変化がみられなかった例は，胃底腺領域型で14.3%，幽門腺領域型で8.3%と胃底腺領域型で多かった．胃底腺領域型と幽門腺領域型で特徴的な内視鏡像が若干異なることを念頭に置き，観察を行うことが重要である．

　The typical endoscopic findings in scirrhous gastric cancer are poor distension of the gastric wall, morphological changes in gastric folds, and a primary lesion. The disease is primarily classified as fundic gland type of gastric cancer with linitis plastica type or as pyloric gland type of gastric cancer with pyloric stenosis. According to the analysis of 143 scirrhous gastric cancer cases, the fundic gland type accounted for the majority（83.2%）. The most common endoscopic finding was poor gastric wall distension, which was observed in 96.5% of cases. Epithelial changes such as erosion and ulcers were not observed in 14.3% and 8.3% of patients with fundic and pyloric gland types, respectively. Notably, the characteristic endoscopic images of the fundic and pyloric gland types are slightly different.