早期胃癌の背景としての胃粘膜―内視鏡的立場より

The Gastric Mucosa as a Background of Localized Lesions of the Stomach Seen from the Standpoint of Endoscopy

　ファイバースコープのおかげで，胃炎とくに慢性胃炎の内視鏡解析も遅々とした歩みながら次第に大きな変革がみられたように思う．

　胃全体からみた巨視的な見方もずいぶん変ってきたし，特殊な方法を用いた微細な見方も最近とみに急速な進歩をとげている．

　Endoscopic analysis of findings in chronic gastritis revealed by fiberscopy has provided us with a great deal of information including studies of atrophic borders as determined by endoscopy, investigations of gastritis in the upper portion of the stomach and endoscopically possible detection of intestinal metaplasia of the gastric mucosa. Close-up and enlarged observation method of the mucosal surface, endoscopic application of findings obtained by stereoscopic microscope or studies of the so-called zonal gastritis may also stand as landmarks of progress in gastric endoscopy. These achievements have been brought about by the cooperation of direct-vision biopsy with the usual observation procedures. At long last, however, the study of chronic gastritis has to pass a critical point as is exemplified by insufficient analysis of mucosal pictures which from the background of localized lesions of the stomach. Materials are as yet deficient to solve this problem and data for analysis are also locking. Nonetheless, it seems that a new and solid direction is opening up, as discussed more minutely in the text, while newer analyses are being made by the application of endoscopic dyeing method along with functional examinations by endoscopy and while the previous ideas and obtained facts are under reconfirmation. A new field is anticipated to loom ahead substantiated by macroscopic and histological studies of ulcer and carcinoma by means of biopsy or staining procedures of the excised specimens.

　Diagnosis of lesions localized within the stomach and confirmation of mucosal changes would surely become easier through the combination of standard endoscopic observations and enlarged views with their practical applications. Interpretation of lesions alone is now becoming insufficient for those of the stomach, be they benign or malignant, and we believe that a stage has now been set where not only analysis of lesions but also that of the neighboring mucosal changes be considered essential for accurate diagnosis of gastric lesions.