胃と腸41巻12号

2006年11月発行

今月の主題 小腸疾患診療の新たな展開 主題

小腸出血性疾患の内視鏡診断―カプセル内視鏡とダブルバルーン内視鏡の役割

著者： 三井啓吾¹ 田中周¹ 江原彰仁¹ 小林剛¹ 関田祥久² 瀬尾継彦¹ 米澤真興¹ 永田和弘¹ 柴田喜明¹ 辰口篤志¹ 藤森俊二¹ 岸田輝幸² 坂本長逸¹

所属機関： ¹日本医科大学消化器内科 ²日本医科大学千葉北総病院内科

ページ範囲：P.1607 - P.1618

要旨　カプセル内視鏡とダブルバルーン内視鏡の小腸出血性疾患の診断における現状と課題について概説した．小腸出血性疾患の診断に両者は非常に有用である．事前のカプセル内視鏡検査の有無によって，ダブルバルーン内視鏡の診断率に有意な差を認めないことから，両者を常に組み合わせて行う必要はないかもしれない．カプセル内視鏡単独での所見陰性とするには疑問があり，ダブルバルーン内視鏡による検査を追加し，現状における“真の陰性”を評価する必要がある．原因不明の消化管出血を認めながら小腸に病変を発見できない症例も経験され，これら症例の詳細を明るみにすることが今後の課題である．

参考文献

1) Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53 : 216-220, 2001

2) Iddan G, Meron G, Glukhovsky A, et al.　Wireless capsule endoscopy. Nature 405 : 417, 2000

3) 三井啓吾，田中周，江原彰仁，他．ダブルバルーン小腸内視鏡検査の有用性―カプセル内視鏡との比較．胃と腸 40 : 1518-1527, 2005

4) Zuckerman GR, Prakash C, Askin MP, et al. AGA technical review on the evaluation and management of occult and obscure gastrointestinal bleeding. Gastroenterology 118 : 201-221, 2000

5) Matsui T, Seki T, Yao K, et al. Usefulness and limitation of Double balloon enteroscopy in inflammatory small bowel disease. Gastrointest Endosc 63 : AB179, 2006

6) Maiden L, Thjodleifsson B, Theodors A, et al. A quantitative analysis of NSAID-induced small bowel pathology by capsule enteroscopy. Gastroenterology 128 : 1172-1178, 2005

7) 八尾恒良，八尾建史，真武弘明，他．小腸腫瘍―最近 5 年間の本邦報告例の集計．胃と腸 36 : 871-881, 2001

8) Yamamoto H, Kita H, Sunada K, et al. Clinical outcomes of Double-balloon endoscopy for the diagnostic and treatment of small-intestinal diseases. Clin Gastroenterol Hepatol 2 : 1010-1016, 2004

9) http://www.givenimaging.com/Cultures/en-US/given/english

10) Tang SJ, Haber GB. Capsule endoscopy in obscure gastrointestinal bleeding. Gastrointest Endosc Clin N Am 14 : 87-100, 2004

11) Pennazio M, Santucci R, Rondonotti E, et al. Outcome of patients with obscure gastrointestinal bleeding after capsule endoscopy : report of 100 consecutive cases. Gastroenterology 126 : 643-653, 2004

12) May A, Wardak A, Nachbar L. Influence of patient selection on the outcome of capsule endoscopy in patients with chronic gastrointestinal bleeding. J Clin Gastroenterol 39 : 684-688, 2005

13) Al Ali J, Wong V, Law J, et al. Predictors for positive outocome in capsule endoscopy for the indication of obscure gastrointestinal bleeding. Gastrointest Endosc 63 : AB178, 2006

14) Selby W. Can clinical features predict the likelihood of finding abnormalities when using capsule endoscopy in patients with GI bleeding of obscure origin? Gastrointest Endosc 59 : 782-787, 2004

15) Bae-Meir S, Eliakim R, Nadler M, et al. Second capsule endoscopy for patients with severe iron deficiency anemia. Gastrointest Endosc 60 : 711-713, 2004

16) Jones BH, Fleischer DE, Sharma VK, et al. Yield of repeat wireless capsule endoscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenteol 100 : 1058-1064, 2005

17) Dhaliwal H, Shapira S, Chung H, et al. Repeated capsule endoscopy : is there a benefit? Gastrointest Endosc 63 : AB148, 2006

18) Matsumoto T, Esaki M, Moriyama T, et al. Comparison of capsule endoscopy and enteroscopy with double-balloon method in patients with obscure bleeding and polyposis. Endoscopy 37 : 827-832, 2004

19) Nakamura M, Niwa Y, Ohmiya N, et al. Preliminary comparison of capsule endoscopy and double-balloon enteroscopy in patients with suspected small-bowel bleeding. Endoscopy 38 : 59-66, 2006

20) Hadithi M, Heine GD, Jacobs MA, et al. A prospective study comparing video capsule endoscopy with double-balloon enteroscopy in patients with obscure gastrointestinal bleeding. Am J Gastroenterol 101 : 52-57, 2006

21) Mehdizadeh S, Ross AS, Leighton J, et al. Double balloon enteroscopy(DBE)compare to capsule endoscopy(CE)among patients with obscure gastrointestinal bleedings(OGIB) : A multicenter U. S. experience. Gastrointest Endosc 63 : AB91, 2006

22) Gay G, Delvaux M, Fassler I. Outcome of capsule endoscopy in determining indication and route for push-and-pull enteroscopy. Endoscopy 38 : 49-58, 2006

23) Appleyard M, Fireman Z, Glukhovsky A, et al. A randomized trial comparing wireless capsule endoscopy with push enteroscopy for the detection of small-bowel lesions. Gastroenterology 119 : 1431-1438, 2000

24) Ross A, Mehdizadeh S, Tokar J, et al. Double balloon enteroscopy for the detection of small bowel mass lesions presenting as obscure gastrointestinal bleeding : do we have a new gold standard? Gastrointest Endosc 63 : AB159, 2006

25) Mitsui K, Tanaka S, Ehara A, et al. Impact of double- balloon endoscopy on clinical management of obscure gastrointestinal bleeding. Gastroenterology 130 : A1, 2006