1)上部消化管の出血性疾患

Hemorrhagic Diseases of the Upper Gastrointestinal Tracts―Endoscopic Differential Diagnoses

要旨　内視鏡検査時に出血性病変を認めた際には，病変をよく洗浄し，詳細に観察することが重要である．出血性病変の中には，しばしば悪性疾患が含まれており，慎重な鑑別診断を要する．上皮性腫瘍では病変辺縁の粘膜内に境界明瞭な領域性を有する病変が存在するのが特徴である．潰瘍性病変，陥凹性病変では形態，潰瘍底・陥凹内の性状，辺縁の所見に注目し鑑別をすすめる．隆起性病変では立ち上がり・表面の性状，周囲の所見に注目し鑑別を行う．また，拡大内視鏡による異常血管や腺管構造の観察は鑑別診断に有用である．一方，十二指腸病変では常に全身疾患との関連を念頭に置き鑑別診断を行うべきである．

　The differential diagnoses of upper gastrointestinal hemorrhagic diseases were summarized in this article. When we find a hemorrhagic lesion, we should wash the lesion and observe it in detail. The hemorrhagic diseases include a lot of malignant diseases, so accurate differential diagnosis is required. Epithelial neoplastic lesions are frequently accompanied by demarcated mucosal lesions, so we should carefully look for such findings. Essential findings of ulcerative and depressed lesions are their shape, surface, edge and circumference. Important findings of protruding lesions are shape of the border, surface and circumference. Moreover, magnifying endoscopic findings of irregular pit and vascular pattern were useful for differential diagnoses. Systemic work up is essential for differential diagnosis of duodenal lesions because there are many kinds of systemic disease in the duodenum.