梶山 徹¹, 西尾 彰功¹, 高鍬 博¹, 兼松 雄象¹, 松末 智²

Tohru KAJIYAMA¹, Akiyoshi NISHIO¹, Hiroshi TAKAKUWA¹, Yuzo KANEMATSU¹, Satoru MATSUSUE²

¹天理よろづ相談所病院消化器内科, ²天理よろづ相談所病院腹部一般外科

¹Department of Gastroenterology, Tenri Hospital, ²Department of Abdominal Surgery, Tenri Hospital

キーワード : Endoscopic ultrasonography, Echo level, Gastric disease

Endoscopic ultrasonography (EUS) enables us to clearly visualize the gastrointestinal tract and surrounding tissue. In ultrasonic study, although echo level plays an important role in qualitative estimation of the lesion, it is hard to appraise echo level objectively. For differential diagnosis of the gastric lesions detected by EUS (Olympus, GF-UM1 and GF-UM2), echo levels were classified into five grades which were based on the comparison with adjacent normal structures. According to this classification, level 0 corresponds to an anechoic pattern, level 1 to the 4th layer of the gastric wall, level 2 to the splenic parenchyma, level 4 to the 3rd layer of the gastric wall and level 3 between level 2 and 4. The optimal distance between the probe and the lesion for adequate evaluation of echo level was 30 to 40 mm. EUS was performed in 439 patients with gastric diseases such as carcinoma, ulcer, lymphoma, polyps and submucosal tumors. 249 histologically defined cases were analysed separately. The results as follows; internal echo of malignant lymphoma was relatively hypoechoic (mainly level 1), in contrast hyperplastic polyp showed relatively hyperechoic pattern (mainly level 3) and gastric cancer was depicted as intermediate echo level tumor between them. (p