胃ポリープの時代的変貌

Historical Transfiguration in Gastric Polyp

　いわゆる胃ポリープについて，この10年来いろいろなことがわかってくると共に，われわれの考え方も随分と変わってきた．

　いわゆる胃ポリープは，比較的稀な疾患と考えられていた．確かに，X線で臨床的に診断され，手術が確認された症例が初めて報告されたのが，何と昭和10年¹⁾（1935）である．それ以後，症例報告はあっても，10例以上まとまった報告例は，戦後の昭和30年代にならないと現われてこない．したがって比較的稀と考えられたのも当然であろう．ちょうど昭和30年代は，胃の診断技術が進歩しはじめるころであり，いわゆる胃ポリープに対する検討も行われはじめたころである．しかし，このころはいわゆる胃ポリープの定義はかなり不明確（現在でも明確とはいえないが）であり，胃の内腔に隆起した病変で一定の形態のものを，いわゆる胃ポリープとして取扱っていた傾向がある²⁾．一般には良性の意味合いが強いが，小さな病変では肉眼的にも良悪性の判別は困難だったと思う．いわゆる胃ポリープの症例を病理組織学的に検索し，癌の症例があると，それを分子として総数で割算し，癌化率何％と計算していたようである．

　Author discussed historical transfiguration in gastric polyp from the clinical aspect. Tremendous change occurred around 1965 and this was apparently brought by rapidly improved technique for early diagnosis of gastric cancer. And nowadays, gastric polyp has become a familiar disease.

　Regarding cancer transformation from the gastric polyp, some polyps may transform into gastric cancer but the possibility seems to be very small. Since diagnostic techniques have improved, it became possible to differentiate benign or malignant gastric polyps, but in borderline cases, especially in diagnosing atypia of gastric polyp, there are still a lot of problems left.

　On the other hand, how does the gastric polyp develop and what is the natural course of the gastric polyp?

　Our study showed that there were wide variation among gastric polyps. Namely, some of them developed suddenly, some of them did not change their sizes, some of them got bigger and some of them disappeared during the course of follow-up. Because of improved technique of the polypectomy, we tend to remove more than certain size of gastric polyps. However, it seems to be necessary to observe natural course of the polyps without removing them. If such study carries out, it could be possible to see more transfiguration in gastric polyp in the future.