食道癌スクリーニングにおけるpanendoscopyの位置づけ

Panendoscopy as the Method of Screening for the Cancer of the Esophagus

要旨　食道癌のスクリーニングとしてのpanendoscopyは診断能が極めて高く有力な手段であるが，診断医の育成，被検者への侵襲，多数の症例を扱えない，などの欠点がある．したがって食道癌のスクリーニングを系統的に行うにはまずX線造影を，それも食道を胃と同時に集団検診体制に乗せて施行すべきである．これにより進行癌ならびに深達度smまでの表在癌を発見することができる．続いて，上部消化管内視鏡検査を施行する際には必ずpanendoscopeで食道も観察する必要があり，特に55歳以上の男性には必須である．少しでも異常を認めたらルゴール染色や生検を行うことにより診断を確定できる．このように，食道癌のスクリーニングにおいてpanendoscopyは二次的な位置にある．対象となるのは表在癌，特にsuperficial flat type，erosive type，plateaulike typeであり，深達度で分けるとep癌，mm癌である．また，食道微小癌も内視鏡診断が威力を発揮する分野であると考える．

　Panendoscopy should be used when the screening for the cancer of the esophagus is done by endoscopy. Screening by endoscopy is useful in that it is highly effective in diagnosis. However, it also has weaknesses such as the problem of the education of physicians, invasions for the examinée and disability for the screening of numerous cases. Thus, the conclusion is that in order to conduct a systematic screening for the cancer of the esophagus, x-ray examination must be performed first for both stomach and esophagus during mass survey programs. Through this, advanced cancers and cases relatively large in size and with submucosal invasion such as the superficial polypoid type or superficial ulcerative type can be discovered. Moreover, when endoscopy is conducted in the upper gastrointestinal tract, the panendoscope should be used for examining the esophagus. This is particularly necessary for men over 55 years old. In case abnormalities are detected, the diagnosis can be confirmed by the Lugol staining method or by biopsy.

　Thus, one can see that panendoscopy is situated in a secondary position as a method of screening for the cancer of the esophagus. Its usage includes those cases of superficial type cancers, especially the superficial flat type, erosive type, and plateau-like type and also ep or mm cancers in the depth of invasion. Endoscopic diagnosis is also effective in identifying esophageal minute cancers. A deeper understanding and concern for the cancer of the esophagus should be aroused in order to detect them at an early stage and thus to save more patients.