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

カプセル内視鏡が診断に有用な疾患―小腸多発腫瘍─悪性リンパ腫を含む

著者： 江崎幹宏¹ 鷲尾恵万¹ 前畠裕司¹ 梅野淳嗣¹ 浅野光一¹ 森山智彦¹ 中村昌太郎¹ 植木隆² 平橋美奈子³ 松本主之¹

所属機関： ¹九州大学大学院病態機能内科学 ²九州大学大学院臨床・腫瘍外科 ³九州大学大学院形態機能病理学

ページ範囲：P.439 - P.448

要旨　小腸多発腫瘍の精査目的で，カプセル内視鏡（CE）を実施した43例のCE所見を遡及的に検討した．腸管濾胞性リンパ腫の小腸病変は，空腸を中心に多発する区域性の白色絨毛ないし白色小隆起の集簇が特徴的であり，高度な十二指腸病変を有する症例で，小腸病変が多発する傾向が強かった．家族性大腸腺腫症では，十二指腸腺腫陽性例のみで空腸に褪色ないし白色調の隆起病変が確認された．また，Peutz-Jeghers症候群では多発性の発赤調有茎性ポリープ，Cowden病では伸長したリンパ濾胞過形成様隆起と暗青色調の血管腫様病変，多発神経内分泌腫瘍では黄白色調の粘膜下腫瘍様隆起を確認しえた．CEは小腸多発腫瘍の検出に有用であるが，本検査の臨床的意義については，さらなる検討が必要と思われた．

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）Triester SL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol 101 : 954-964, 2006

3）Ladas SD, Triantafyllou K, Spada C, et al. European Society of Gastrointestinal Endoscopy（ESGE）: recommendations（2009）on clinical use of video capsule endoscopy to investigate small-bowel, esophageal and colonic diseases. Endoscopy 42 : 220-227, 2010

4）Spigelman AD, Williams CB, Talbot IC, et al. Upper gastrointestinal cancer in patients with familial adenomatous polyposis. Lancet 2 : 783-785, 1989

5）Yoshino T, Miyake K, Ichimura K, et al. Increased incidence of follicular lymphoma in the duodenum. Am J Surg Pathol 24 : 688-693, 2000

6）Sato Y, Ichimura K, Tanaka T, et al. Duodenal follicular lymphomas share common characteristics with mucosa-associated lymphoid tissue lymphomas. J Clin Pathol 61 : 377-381, 2008

7）Nakamura S, Matsumoto T, Umeno J, et al. Endoscopic features of intestinal follicular lymphoma : the value of double-balloon enteroscopy. Endoscopy 39（Suppl 1）: E26-27, 2007

8）Esaki M, Matsumoto T, Nakamura S, et al. Capsule endoscopy findings in intestinal follicular lymphoma. Endoscopy 39 : E86-87, 2007

9）Kodama M, Kitadai Y, Shishido T, et al. Primary follicular lymphoma of the gastrointestinal tract : a retrospective case series. Endoscopy 40 : 343-346, 2008

10）Higuchi N, Sumida Y, Nakamura K, et al. Impact of double-balloon endoscopy on the diagnosis of jejunoileal involvement in primary intestinal follicular lymphomas : a case series. Endoscopy 41 : 175-178, 2009

11）Matsumoto T, Nakamura S, Esaki M, et al. Double-balloon endoscopy depicts diminutive small bowel lesions in gastrointestinal lymphoma. Dig Dis Sci 55 : 158-165, 2010

12）Takata K, Okada H, Ohmiya N, et al. Primary gastrointestinal follicular lymphoma involving the duodenal second portion is a distinct entity : a multicenter, retrospective analysis in Japan. Cancer Sci 102 : 1532-1536, 2011

13）Mata A, Llach J, Castells A, et al. A prospective trial comparing wireless capsule endoscopy and barium contrast series for small-bowel surveillance in hereditary GI polyposis syndromes. Gastrointest Endosc 61 : 721-725, 2005

14）Caspari R, von Falkenhausen M, Krautmacher C, et al. Comparison of capsule endoscopy and magnetic resonance imaging for the detection of polyps of the small intestine in patients with familial adenomatous polyposis or with Peutz-Jeghers' syndrome. Endoscopy 36 : 1054-1059, 2004

15）Burke CA, Santisi J, Church J, et al. The utility of capsule endoscopy small bowel surveillance in patients with polyposis. Am J Gastroenterol 100 : 1498-1502, 2005

16）Schulmann K, Hollerbach S, Kraus K, et al. Feasibility and diagnostic utility of video capsule endoscopy for the detection of small bowel polyps in patients with hereditary polyposis syndromes. Am J Gastroenterol 100 : 27-37, 2005

17）Wong RF, Tuteja AK, Haslem DS, et al. Video capsule endoscopy compared with standard endoscopy for the evaluation of small-bowel polyps in persons with familial adenomatous polyposis（with video）. Gastrointest Endosc 64 : 530-537, 2006

18）Brown G, Fraser C, Schofield G, et al. Video capsule endoscopy in Peutz-Jeghers syndrome : a blinded comparison with barium follow-through for detection of small-bowel polyps. Endoscopy 38 : 385-390, 2006

19）Iaquinto G, Fornasarig M, Quaia M, et al. Capsule endoscopy is useful and safe for small-bowel surveillance in familial adenomatous polyposis. Gastrointest Endosc 67 : 61-67, 2008

20）Katsinelos P, Kountouras J, Chatzimavroudis G, et al. Wireless capsule endoscopy in detecting small-intestinal polyps in familial adenomatous polyposis. World J Gastroenterol 15 : 6075-6079, 2009

21）Günther U, Bojarski C, Buhr HJ, et al. Capsule endoscopy in small-bowel surveillance of patients with hereditary polyposis syndromes. Int J Colorectal Dis 25 : 1377-1382, 2010

22）Clarke JO, Giday SA, Magno P, et al. How good is capsule endoscopy for detection of periampullary lesions ? Results of a tertiary-referral center. Gastrointest Endosc 68 : 267-272, 2008

23）Pohl J, Aschmoneit I, Schuhmann S, et al. Computed image modification for enhancement of small-bowel surface structures at video capsule endoscopy. Endoscopy 42 : 490-492, 2010

24）Hatogai K, Hosoe N, Imaeda H, et al. Role of enhanced visibility in evaluating polyposis syndromes using a newly developed contrast image capsule endoscope. Gut Liver 6 : 218-222, 2012

25）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

26）Fry LC, Neumann H, Kuester D, et al. Small bowel polyps and tumours : endoscopic detection and treatment by double-balloon enteroscopy. Aliment Pharmacol Ther 29 : 135-142, 2009

27）Giardiello FM, Brensinger JD, Tersmette AC, et al. Very high risk of cancer in familial Peutz-Jeghers syndrome. Gastroenterology 119 : 1447-1453, 2000

28）Giardiello FM, Welsh SB, Hamilton SR, et al. Increased risk of cancer in the Peutz-Jeghers syndrome. N Engl J Med 316 : 1511-1514, 1987

29）Giardiello FM, Trimbath JD. Peutz-Jeghers syndrome and management recommendations. Clin Gastroenterol Hepatol 4 : 408-415, 2006

30）Salloch H, Reinacher-Schick A, Schulmann K, et al. Truncating mutations in Peutz-Jeghers syndrome are associated with more polyps, surgical interventions and cancers. Int J Colorectal Dis 25 : 97-107, 2010

31）Bender GN, Maglinte DD, McLarney JH, et al. Malignant melanoma : patterns of metastasis to the small bowel, reliability of imaging studies, and clinical relevance. Am J Gastroenterol 96 : 2392-2400, 2001

32）Takeda T, Shibuya T, Osada T, et al. Metastatic renal cell carcinoma diagnosed by capsule endoscopy and double balloon endoscopy. Med Sci Monit 17 : CS15-17, 2011

33）Prakoso E, Fulham M, Thompson JF, et al. Capsule endoscopy versus positron emission tomography for detection of small-bowel metastatic melanoma : a pilot study. Gastrointest Endosc 73 : 750-756, 2011