残胃多発早期癌の1例―残胃の癌の内視鏡診断

Endoscopic Diagnosis of Gastric Cancer in the Remnant Stomach

　胃内視鏡器機の進歩，改良により，今日では胃内全域を盲点なく観察することができる．しかし，残胃では手術による胃の変形や残胃の大きさにより，残胃全体を十分に観察することは困難なことが多く，残胃に発見される胃癌の多くは進行癌で，早期癌の報告は少ない．今回，われわれは初回手術4年後の残胃多発早期胃癌の1例を提示すると共に，残胃の癌の内視鏡診断成績とその対策について報告する．

　In our clinic, 19 gastric cancers were found in the remnant stomach of 17 patients after gastrectomy for gastric cancer. Grossly, these cancers were chiefly polypoid and histologically differentiated adenocarcinoma. A correct diagnosis was made before operation in all patients except two cases: in these two cases gastrofiberscope could not be inserted because they were associated with esophageal stenosis. Moreover, in three cases a correct diagnosis was not provided at the first endoscopic examination. In the two cases, the endoscopic diagnosis was either a benign gastric ulcer or a lesion near the cardiac orifice that was entirely missed. In the remaining one case, results of the biopsy was normal in contrast to visual diagnosis. A small caliber, forward-viewing fiberscope with short bending section was highly effective inside the limited space of the cavity of the resected stomach. Retroflexion by a side-viewing fiberscopes in the resected stomach was often difficult. For early detection of gastric cancers in the resected stomach, the patients must be followed-up by a periodic endoscopic examination after gastrectomy. The Congo red-methylene blue test developed in our clinic was also useful for early diagnosis of gastric cancer in the resected stomach. In this test, gastric cancers could be observed as White areas where the Congo red and methylene blue were bleached.