胃と腸43巻6号

2008年05月発行

今月の主題 大腸の新しい画像診断 主題

大腸の新しい内視鏡診断―炎症性疾患に対するnarrow band imaging（NBI）

著者： 松本主之¹ 工藤哲司¹ 江崎幹宏¹ 矢田親一朗¹ 古賀秀樹¹ 中村昌太郎¹ 飯田三雄¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学

ページ範囲：P.893 - P.900

要旨　narrow band imaging（NBI）内視鏡は光源の波長をヘモグロビン吸収特性領域に狭帯域化した画像強調内視鏡である．潰瘍性大腸炎におけるNBI観察では，活動期粘膜の腺口開口部や絨毛状粘膜が明瞭となり，緩解期粘膜では血管構築の判定が可能となる．さらに，NBI拡大観察により活動期粘膜では腺口開口部と絨毛状粘膜がより明確に区別され，緩解期粘膜の血管は規則的な蜂巣状血管と不規則血管に大別できる．一方，潰瘍性大腸炎に合併する腫瘍性病変では大小不同のある不整絨毛状粘膜が観察される．以上のように，NBI内視鏡検査を用いることで，潰瘍性大腸炎の病態が血管および腺管構造の点から細分化可能であり，それらの中から腫瘍性病変の拾い上げも可能と思われる．

参考文献

1) Gono K, Obi T, Yamaguchi M, et al. Appearance of enhanced tissue features in narrow-band endoscopic imaging. J Biomed Optics 9:568-577, 2004

2)松本主之，工藤哲司，中村昌太郎，他．潰瘍性大腸炎におけるnarrow band imaging(NBI)観察．胃と腸 40:1425-1428, 2005

3)松本主之，工藤哲司，飯田三雄，他．拡大内視鏡とNBIで探る潰瘍性大腸炎の再生粘膜．消化器内視鏡 18:1314-1321, 2006

4)松本主之，工藤哲司，飯田三雄．NBIと臨床―炎症性腸疾患の診断:炎症粘膜の評価．早期大腸癌 11:143-148, 2007

5)松本主之，工藤哲司，八尾隆史，他．潰瘍性大腸炎におけるNBI観察の有用性．胃と腸 42:877-881, 2007

6) Matsumoto T, Kudo T, Jo Y, et al. Magnifying colonoscopy with narrow band imaging system for the diagnosis of dysplasia in ulcerative colitis:a pilot study. Gastrointest Endosc 66:957-965, 2007

7)斉藤裕輔，藤谷幹浩，前本篤男，他．潰瘍性大腸炎難治化の予測における拡大内視鏡の有用性．胃と腸 40:1417-1423, 2005

8) Fujiya M, Saitoh Y, Nomura M, et al. Minute findings by magnifying colonoscopy are useful for the evaluation of ulcerative colitis. Gastrointest Endosc 56:535-542, 2002

9) Matsumoto T, Kuroki F, Mizuno M, et al. Application of magnifying chromoscopy for the assessment of severity in patients with mild to moderate ulcerative colitis. Gastrointest Endosc 46:400-405, 1997

10) Kunihiro M, Tanaka S, Sumii M, et al. Magnifying colonoscopic features of ulcerative colitis reflect histologic inflammation. Inflamm Bowel Dis 10:737-744, 2004

11) Nishio Y, Ando T, Maeda O, et al. Pit patterns in rectal mucosa assessed by magnifying colonoscope are predictive of relapse in patients with quiescent ulcerative colitis. Gut 55:1768-1773, 2006

12) Dekker E, van den Broek FJ, Reitsma JB, et al. Narrow-band imaging compared with conventional colonoscopy for the detection of dysplasia in patients with longstanding ulcerative colitis. Endoscopy 39:216-221, 2007

13) East JE, Suzuki N, von Herbay A, et al. Narrow band imaging with magnification for dysplasia detection and pit pattern assessment in ulcerative colitis surveillance:a case with multiple dysplasia associated lesions or masses. Gut 55:1432-1435, 2006

14) Fujiya M, Watari J, Moriichi K, et al. Autofluorescence imaging is useful to assess activity of ulcerative colitis. Digest Endosc 19:s145-s149, 2007

15) Watanabe K, Yamagami H, Oshitani N, et al. Potential of autofluorescence colonoscopy for patients with ulcerative colitis. Digest Endosc 19:s150-s152, 2007

16) Matsumoto T, Kudo T, Yao T, et al. Autofluorescence imaging colonoscopy in ulcerative colitis:comparison with conventional and narrow-band imaging colonoscopy. Digest Endosc 19:s139-s144, 2007

17) Matsumoto T, Moriyama T, Yao T, et al. Autofluorescence imaging colonoscopy for the diagnosis of dysplasia in ulcerative colitis. Inflamm Bowel Dis 13:640-641, 2007

18) Kiesslich R, Burg J, Vieth M, et al. Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 127:706-713, 2004

19) Kiesslich R, Goetz M, Lammersdorf K, et al. Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 132:874-882, 2007

20) Hurlstone DP, Kiesslich R, Thomson M, et al. Confocal chromoscopic endomicroscopy is superior to chromoscopy alone for the detection and characterisation of intraepithelial neoplasia in chronic ulcerative colitis. Gut 57:196-204, 2008