胃と腸42巻5号

2007年04月発行

特集 消化管の拡大内視鏡観察2007 各論 1. 咽頭・食道

4) Barrett粘膜・食道の拡大内視鏡診断―NBI拡大内視鏡による微細粘膜・毛細血管patternの解析

著者： 郷田憲一¹ 田尻久雄¹² 池上雅博³ 伊藤恭子² 米澤仁¹ 吉田幸永¹ 加藤正之¹ 益子貴博¹ 吉村昇¹ 仲吉隆¹ 貝瀬満¹

所属機関： ¹東京慈恵会医科大学内視鏡科 ²東京慈恵会医科大学消化器・肝臓内科 ³東京慈恵会医科大学病理

ページ範囲：P.683 - P.690

要旨　発癌母地として重要視されるBarrett粘膜・食道内の特殊腸上皮化生（specialized intestinal metaplasia；SIM）の内視鏡診断におけるNBI（narrow band imaging）拡大観察の有用性について検討した．58例のBarrett粘膜・食道211か所のNBI拡大内視鏡像と組織像とを対比検討した．微細粘膜模様（fine mucosal pattern；FMP）・毛細血管像（capillary pattern；CP）を，それぞれ4種類（FMP-1～4，CP-I～IV）に分類した．各FMP，CPにおいてSIM存在率およびSIM診断のaccuracy，odds ratioについて検討した結果，最も高値を示したのは，FMP-4（cerebriform）とCP-IV（ivy-like or DNA-spiral-like）であった．CP-IVはFMP-4に比し，いずれの検討においても，より高い値を示した．統計学的解析では，FMPのみよりFMP＋CPによるSIM診断のほうが，有意にその精度が高かった．明瞭にCPを描出しえるNBI拡大内視鏡は，より的確なSIMの拾い上げに有用であることが示唆された．

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