3) 胃

Technique of Magnifying Endoscopy for Gastric Lesion

要旨　拡大内視鏡検査は，微小病変や側方進展範囲診断が困難な症例に有用である．本稿では，筆者らが拡大内視鏡検査を行ううえで日常注意していることを中心に，拡大観察を前提とした通常観察のコツと拡大観察のコツを解説し，拡大観察が有用と考えられた症例を提示する．拡大観察の実際は，通常観察において色調の変化・凹凸の変化を境界のある領域として捉え，同境界を拡大観察で詳細に観察したのち，同領域の血管パターン・表面微細構造を観察し，質的診断を行う．この際，拡大観察に固執してしまい，同時多発癌を見落とすことがないように十分な通常観察も必要である．

　The diagnosis of a minute lesion or lateral extension of early gastric cancer is sometimes difficult with conventional endoscopy. Magnifying endoscopy is able to yield very clear images of the fine mucosal patterns of the gastric pits and the micro-vessels on the mucosal surface. Therefore, the additional findings of magnifying endoscopy could aid precise diagnosis. However, we should recognize that the findings of conventional endoscopy are important, in addition to those of magnifying endoscopy. When we persist in the findings of magnifying endoscopy, we might miss a second lesion. We have to remember that a patient with a gastric cancer lesion often has another lesion in the stomach.