腸上皮化生の内視鏡診断に関する臨床的研究

抄録

In 1964 Takemoto et al. came across a case in which grayish-white protrusions were seen scattered about in the gastric antrum endoscopically. It was further found after gastrectomy that they were caused by intestinal metaplasia. Convinced that such a case could be not infrequently encountered on careful observation, author have since then set about to tackle with the possibility of endoscopic diagnosis of intestinal metaplasia in the gastric mucosa. "Definition of specific type of intestinal metaplasia" Endoscopically, grayish-white protrusions of varying size are seen here and there in the antrum. They mimic "Stepping Stone" in the Japanese garden, in the resected stomach. Elevated parts correspond to hyperplasia of mucosa associated with marked intestinal metaplasia, while depressed parts between them show severe atrophic gastritis with no trace of intestinalization. Auther defined the word of "specific type of intestinal metaplasia" the only type which has endoscopical and histological characteristics as above. "Roof slate type of intestinal metaplasia" Areas clearly discolored in milky-white as seen by endoscopy extend over relatively flat mucosal surface, and intestinal metaplasia is to be seen almost over their whole extent. "Scattered rice grain type of intestinal metaplasia" From the antrum up to the level of the gastric angle lied grayish-white protrusions scattered about on the mucosa as if rice grains had been pasted on its surface. "Snow fleck type of intestinal metaplasia" From gastric angle toward corpus several streaks of "Kammrötung" were seen, with white small granulas like snow fleck on them. "Classification of the histological findings of intestinal metaplasia diagnosed endoscopically" Resected stomachs of 19 cases which were diagnosed endoscopically examined histologically. Author classified them 4 types, I type (specific type of intestinal metaplasia), II type, III type, IV type (roof slate type of intestinal metaplasia). "Factors which influence endoscopic diagnosis of intestinal metaplasia" Endoscopic appearance may vary, depending upon such factors as the quality of the source of light, distensibility of gastric wall and the presence of as-sociated superficial gastritis. "Incidence of intestinal metaplasia diagnosed endoscopically and confirmed by biopsy" It may be too early as yet to refer to its frequency from the view point of endoscopy. But at least in the author's estimation, out of 5, 687 cases including both out and inpatients examined by FGS-C and FGS-CL 126 cases (2.2%) with endoscopically diagnosed intestinal metaplasia were later confirmed as such by biopsy. Up to this time intestinal metaplasia was diagnosedd only by histological examination. Owing to the excellent development of endoscopy, recently endoscopic observation become finer and more acurate. Author made it possible to diagnose some types of intestinal metaplasia by usual endoscopical examination.