腹腔動脈内色素注入法による胃病変の内視鏡的観察

―胃癌の新しい内視鏡的診断法(第3報)―

抄録

At the 3rd European Congress of Gastro-intestinal Endoscopy (Budapest, 1976), the present authors have reported the findings of the blood flow in the gastric mucosa of the corpus and the antrum and the endoscopic findings of stomach cancer by means of dye (10 ml. of 0.1 w/v% Evans Blue or 0.2 w/v % Indigo carmine) infusion into celiac artery. Thereafter, the blood flow and the supplying area of the left gastric and right gastro-epiploic arteries were observed by I. A. D. method with superselectivec annulation into these arteries (Figure 1 and Figure 2). In 48 lesions of 44 patients with stomach cancer, the hemodynamics in the lesions and their surrounding mucosa was observed. To prove the significance of I. A. D. method, the microvascular patterns were compared between mucosal lesions of cancer and their surrounding area. In the lesion of well differentiated adenocarcinoma, the mucosal vessels are decreased in number with evident varieties of turtuous, dilated and cystic patterns (Figure 4). And so, the endoscopic findings of the redness in those lesions of well differentiated adenocarcinoma are considered to be due to the blood pooling in those dilated and cystic vessels in the mucosa orr submucosa (Figure 3). On the other hand, in the lesion of pooly differentiated adenocarcinoma (signet ring cell carcinoma), the mucosal vessels of the lesions are extreamly decreased in number with fine and chaotic petterns, comparing to those of the surrounding normal mucosa (Figure 6). The endoscopic findings of discoloration in lesion of poorly differentiated adenocarcinoma are due to those poor vascularisation (Figure 5). The deformity of mucosal vascular mesh in malignant lesions corresponded with fundamental types of involving carcinoma. And so, the I. A. D. method would serve in observation of the abnormal hemodynamics, at the border between malignancy and surrounding area. Recent method of I. A. D. using vasoconstrictor (epinephrine 10 μg.) revealed that the cancerous lesion is more clearly demarcated from surrounding mucosa in early lesion of well differentiated adenocarcinoma than I. A. D, photographs without vasoconstrictor (Figure 7). Therefore, the use of vasodilator in poorly differentiated adenocarcinoma, on the contrary, the application of those medicaments in I. A. D. method (pharmaco-I. A. D. or P. I. A. D. method) would be and useful diagnostic approach for determination of extent of cancer spread in the mucosa or submucosa, which is so difficult to point out as “poor distensibility” or “rigidity” of the stomach wall by means of fluoroscopic examination. By further improvement of the procedure of I. A. D. method, this new technique of endoscopic examination would serve in pathologic or physiological study on not only stomach but also other digestive organs.