胃と腸45巻10号

2010年09月発行

今月の主題 Crohn病小腸病変に対する診断と治療の進歩 主題

Crohn病小腸病変の診断と経過―バルーン内視鏡の有用性と位置づけ─ダブルバルーン内視鏡

著者： 砂田圭二郎¹ 矢野智則¹ 宮田知彦¹ 西村直之¹ 三浦義正¹ 新畑博英¹ 佐藤博之¹ 山本博徳¹

所属機関： ¹自治医科大学内科学講座消化器内科学部門

ページ範囲：P.1605 - P.1612

要旨　Crohn病診療におけるダブルバルーン内視鏡の有用性は，診断においては，特徴的な内視鏡所見を詳細に観察し，同時に生検組織が得られることである．小腸には潰瘍を生じる様々な疾患があり，潰瘍の腸間膜付着側への偏在性や偏向性の確認も鑑別診断に役立つ．また，Crohn病の治療では，mucosal healingという質の高い目標を置くことが推奨されつつあり，ダブルバルーン内視鏡により定期的な観察を行い，現在の治療が適正であるかどうかの評価と，それに基づいた治療変更をすることが望まれる．技術面では，深い潰瘍をオーバーチューブで越えて挿入する場合には，穿孔を起こす危険性があり注意を要する．深い潰瘍が存在する場合や癒着で挿入が難しい場合は，内視鏡を挿入しなくても選択的造影を行えば，より深部の情報を得ることができる．

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