胃と腸46巻12号

2011年11月発行

今月の主題 Barrett食道癌の診断 主題

Barrett食道癌の内視鏡診断―IEEを用いた拾い上げ診断のポイント

著者： 郷田憲一¹ 土橋昭¹ 吉村昇¹ 炭山和毅¹ 豊泉博史¹ 加藤智弘¹ 田尻久雄¹² 池上雅博³ 貝瀬満⁴

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 ⁴虎の門病院消化器内科

ページ範囲：P.1826 - P.1834

要旨　表在性Barrett腺癌の早期発見において，まずは通常内視鏡で発赤・凹凸不整の所見を見落とさないことが重要である．次に拡大内視鏡を併用したNBI観察を行う際には，最初に中等度拡大観察でBarrett粘膜・食道全体を観察する．腫瘍を疑う病変を認めた際，その辺縁から中心へと病変全体を観察し，粘膜模様の異常所見（不整な粘膜模様や粘膜模様の微小化・消失）の有無とその領域性（demarcation lineの有無）について評価する．その後，拡大率を上げて，不整な微小血管像（拡張と形状不均一）の有無を評価する．この診断手順を応用すれば，NBI拡大内視鏡は拾い上げ診断に加え，内視鏡的切除術前の腫瘍範囲診断においても強力な診断ツールとなりえる．

参考文献

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