片岡 伸一¹, 井出 満², 黒原 進司², 栄 則久², 大地 宏昭¹, 豊永 高史¹, 土細工 工利夫¹, 藤吉 朗¹, 杉山 健¹, 杉山 理恵子¹, 許 泰志¹, 湯浅 肇³, 廣岡 大司¹

Shinichi KATAOKA¹, Mituru IDE², Shinji KUROHARA², Norihisa SAKAE², Hiroaki OOCHI¹, Takashi TOYONAGA¹, Toshio DOZAIKU¹, Akira FUJIYOSHI¹, Takeshi SUGIYAMA¹, Rieko SUGIYAMA¹, Yasushi KYO¹, Hajime YUASA³, Takashi HIROOKA¹

¹岸和田徳洲会病院内科, ²岸和田徳洲会病院腹部超音波室, ³天竜厚生会さいわい医療保健部

¹Department of Internal Medicine Kishiwada Tokusyukai Hospital, 4-22-38 Isonokami-cho, Kishiwada-shi, Osaka　596-0001, Japan, ²Department of Abdominal Ultrasonography Kishiwada Tokusyukai Hospital, 4-22-38 Isonokami-cho, Kishiwada-shi, Osaka　596-0001, Japan, ³Department of Health Insurance Tenryu Koseikai Saiwai Hospital, 217-3 Watagashima, Tenryu-shi, Shizuoka-ken 431-23, Japan

キーワード : Duodenal ulcer, Endoscopy, Gastric ulcer, Gastrointestinal bleeding, Ultrasonography

Objective: To assess the usefulness of pre-endoscopic ultrasonography to detect peptic ulcers in patients with upper gastrointestinal bleeding.
Subjects and Methods: Extracorporeal ultrasonography was performed on 465 patients with upper gastrointestinal bleeding prior to endoscopic examination. The diagnosis of peptic ulcer was made when criteria 1 and 2 or 1 and 3 were present, where 1 indicates localized mural wall thickening; 2, exhibition of ulcer contour; and 3, high ulcer echo.
Results: The sensitivity of ultrasonography for gastric ulcers was 43.3%; its specificity was 96.4%. Sensitivity was highest at the gastric angle lesser curvature (76%). It was high (67%) in the angle, whereas it decreased in higher ulcer locations (33% at the upper corpus). Sensitivity was low (33%) in the antrum but was high in the lesser curvature (68%) and low in the greater curvature (19%). The sensitivity of ultrasonography for duodenal ulcer was 53.6%; specificity was 97.3%. Sensitivity in the bulbus was high at the anterior wall (67%) and low at the posterior wall (10%).
Conclusion: The specificity of ultrasonography for hemorrhagic peptic ulcer was high; sensitivity, however, varied with the location of the lesion.