臨床の場における上部消化管スクリーニング法―X線の立場より

Clinical Screening Method of the Upper Gastrointestinal Tract Lesions

　上部消化管のスクリーニングは，まずX線検査，次いで内視鏡検査というのが従来から常識的に行われている方法である．

　ところが，第24回日本消化器内視鏡学会総会（1982年5月）のパネルディスカッション，“上部消化管スクリーニング法として内視鏡検査はX線検査にかわりうるか?”で討議されたように，内視鏡装置の進歩に伴って，従来とは異なった発想が生まれようとしている．しかし，本当に内視鏡はX線にかわりうるのか，われわれX線診断を行う側からは，大いに関心のあるところである．

　Regarding routine screening methods of the upper G.I. tract, especially for screening methods for gastric lesions, we discussed an efficacy of radiological examination by comparing with that of endoscopic examination.

　Materials: Among new patients in 1981 at National Cancer Center Hospital, 183 cases, who were confirmed to have gastric cancer by both radiologic and endoscopic examinations and underwent gastrectomy, were selected. They included 97 cases of single advanced gastric cancer, 65 cases of single early gastric cancer and 21 cases of multiple gastric cancer (45 lesions). We devided these cases into two groups, namely radiologic examination preceded group and endoscopic examination preceded group. Then we compared their screening ability to pick up the gastric lesions.

　Results: Single advanced gastric cancer was picked up 100% by either radiologic examination preceded group or endoscopic examination preceded group. Single early gastric cancer was picked up 91.7% by radiologic examination preceded group and 96.6% by endoscopic examination preceded group, so there were little difference between both examinations. For the multiple gastric cancers, all cases could be picked up by either radiologic or endoscopic examination. However, it was difficult to pick up all lesions in such cases by radiologic examination and endoscopic examination in the routine screening. In either radiologic or endoscopic examination, the following examination had much advantages on detecting the lesion than the preceded examination.

　These results indicate that the endoscopic examination will not take the place of the radiologic examination as gastric screening method. Radiologic examination may have disadvantages on x-ray exposure, however it has been becoming possible to get clear x-ray picture with very low dose of x-ray exposure. In fact, the radiologic examination is a safe and noninvasive screening method and has more advantages than endoscopic examination.

　Therefore, we feel that the radiologic examination will be a more important screening tool for the upper G.I. tract from now on.