胃と腸48巻4号

2013年04月発行

今月の主題 カプセル内視鏡の現状と展望

主題

カプセル内視鏡の現状と展望―診断精度向上の工夫

著者： 塩谷昭子¹ 本多啓介² 河上真紀子³ 山中義之¹ 藤田譲¹ 松本啓志¹ 垂水研一¹ 楠裕明² 眞部紀明⁴ 畠二郎⁴ 春間賢¹

所属機関： ¹川崎医科大学消化管内科学 ²川崎医科大学総合臨床医学 ³川崎医科大学附属病院内視鏡センター ⁴川崎医科大学検査診断学（内視鏡・超音波）

ページ範囲：P.410 - P.417

文献概要

要旨　小腸カプセル内視鏡（CE）検査の診断率の向上のためには，リアルタイムビューアーの活用，前処置の工夫，読影精度の向上が要求される．リアルタイムで観察し，食道・胃内にCEがとどまるようであれば，飲水負荷，体位変換，プロカイネティクスの投与や，上部内視鏡による誘導などで対処する．腸管洗浄剤の投与は，回腸遠位側の画像改善に有用であるが，CE検査の受容性を損ねる可能性がある．読影初心者の病変検出率は，読影熟練内視鏡技師と比較して低い．また，有意な病変を見落とさないためには，読影熟練者2人による読影が必要である．画像読影の内視鏡医の負担を軽減し，診断効率を改善するためには，読影技師の育成と精度の高い読影支援ソフトの開発が期待される．

参考文献

1）Mergener K, Ponchon T, Gralnek I, et al. Literature review and recommendations for clinical application of small-bowel capsule endoscopy, based on a panel discussion by international experts. Consensus statements for small-bowel capsule endoscopy, 2006/2007. Endoscopy 39 : 895-909, 2007

2）Cave DR, Fleischer DE, Leighton JA, et al. A multicenter randomized comparison of the Endocapsule and the Pillcam SB. Gastrointest Endosc 68 : 487-494, 2008

3）Shiotani A, Honda K, Kawakami M, et al. Analysis of small-bowel capsule endoscopy reading by using Quickview mode : training assistants for reading may produce a high diagnostic yield and save time for physicians. J Clin Gastroenterol 46 : e92-e95, 2012

4）中村正直，後藤秀実．カプセル内視鏡における読影法．Gastroenterol Endosc 53 : 3568-3575, 2011

5）Lewis BS, Swain P. Capsule endoscopy in the evaluation of patients with suspected small intestinal bleeding : Results of a pilot study. Gastrointest Endosc 56 : 349-353, 2002

6）Mylonaki M, Fritscher-Ravens A, Swain P. Wireless capsule endoscopy : a comparison with push enteroscopy in patients with gastroscopy and colonoscopy negative gastrointestinal bleeding. Gut 52 : 1122-1126, 2003

7）Saurin JC, Delvaux M, Gaudin JL, et al. Diagnostic value of endoscopic capsule in patients with obscure digestive bleeding : blinded comparison with video push-enteroscopy. Endoscopy 35 : 576-584, 2003

8）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

9）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

10）Matsumoto T, Esaki M, Moriyama T, et al. Comparison of capsule endoscopy and enteroscopy with the double-balloon method in patients with obscure bleeding and polyposis. Endoscopy 37 : 827-832, 2005

11）Fujimori S, Seo T, Gudis K, et al. Diagnosis and treatment of obscure gastrointestinal bleeding using combined capsule endoscopy and double balloon endoscopy : 1-year follow-up study. Endoscopy 39 : 1053-1058, 2007

12）Teshima CW, Kuipers EJ, van Zanten SV, et al. Double balloon enteroscopy and capsule endoscopy for obscure gastrointestinal bleeding : an updated meta-analysis. J Gastroenterol Hepatol 26 : 796-801, 2011

13）Shiotani A, Honda K, Kawakami M, et al. Use of an external real-time image viewer coupled with prespecified actions enhanced the complete examinations for capsule endoscopy. J Gastroenterol Hepatol 26 : 1270-1274, 2011

14）塩谷昭子，西隆司，垂水研一，他．実践的カプセル内視鏡─小腸用カプセル内視鏡に前処置は必要か?消内視鏡 22 : 303-307, 2010

15）Shiotani A, Honda K, Kawakami M, et al. Evaluation of RAPID® 5 Access software for examination of capsule endoscopies and reading of the capsule by an endoscopy nurse. J Gastroenterol 46 : 138-142, 2011

16）Shiotani A, Opekun AR, Graham DY. Visualization of the small intestine using capsule endoscopy in healthy subjects. Dig Dis Sci 52 : 1019-1025, 2007

17）Rokkas T, Papaxoinis K, Triantafyllou K, et al. Does purgative preparation influence the diagnostic yield of small bowel video capsule endoscopy ? : A meta-analysis. Am J Gastroenterol 104 : 219-227, 2009

18）Spada C, Riccioni ME, Familiari P, et al. Polyethylene glycol plus simethicone in small-bowel preparation for capsule endoscopy. Dig Liver Dis 42 : 365-370, 2010

19）Postgate A, Tekkis P, Patterson N, et al. Are bowel purgatives and prokinetics useful for small-bowel capsule endoscopy ? A prospective randomized controlled study. Gastrointest Endosc 69 : 1120-1128, 2009