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―小腸潰瘍─炎症性腸疾患を中心に

著者： 能田貞治¹ 井上拓也¹ 太田和寛¹ 坂中太輔¹ 原田智¹ 藤原薫¹ 江戸川祥子¹ 楢林賢¹ 柿本一城¹ 石田久美¹ 倉本貴典¹ 阿部洋介¹ 竹内利寿¹ 時岡聡¹ 梅垣英次¹ 樋口和秀¹

所属機関： ¹大阪医科大学第2内科

ページ範囲：P.449 - P.456

要旨　カプセル内視鏡（CE）は，病変の描出能が高く，低侵襲であることから，Crohn病（CD）の診療に非常に有用である．臨床的活動度であるCDAI（Crohn's disease activity index）で寛解と判断される症例の中には，内視鏡的に活動性を有する症例もみられる．そのため，CDの病勢の評価には，内視鏡的な小腸病変の評価が重要であり，CEが果たす役割が大きいと考えられる．ただし，CEのみではCDの初発時の診断は困難で，また，滞留の危険性もあるため，ほかのモダリティーと相補的に検査を行うことが重要である．

参考文献

1）Iddan G, Meron G, Glukhovsky A, et al. Wireless capsule endoscopy. Nature 405 : 417, 2000

2）Yamamoto H, Sekine Y, Sato Y, et al. Total enteroscopy with a nonsurgical steerable double-balloon method. Gastrointest Endosc 53 : 216-220, 2001

3）飯田三雄，富永雅也，八尾恒良．クローン病の臨床像症状─一般検査からみた病像．Pharma Medica 10 : 31-36, 1992

4）Mishkin DS, Chuttani R, Croffie J, et al. ASGE Technology Status Evaluation Report : wireless capsule endoscopy. Gastrointest Endosc 63 : 539-545, 2006

5）Sidhu R, Sanders DS, Morris AJ, et al. Guidelines on small bowel enteroscopy and capsule endoscopy in adults. Gut 57 : 125-136, 2008

6）Peyrin-Biroulet L, Loftus EV Jr, Colombel JF, et al. Early Crohn disease : a proposed definition for use in disease-modification trials. Gut 59 : 141-147, 2010

7）Devlin SM, Panaccione R. Evolving inflammatory bowel disease treatment paradigms : top-down versus step-up. Med Clin North Am 94 : 1-18, 2010

8）Marmo R, Rotondano G, Piscopo R, et al. Capsule endoscopy versus enteroclysis in the detection of small-bowel involvement in Crohn's disease : a prospective trial. Clin Gastroenterol Hepatol 3 : 772-776, 2005

9）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

10）Jensen MD, Nathan T, Rafaelsen SR, et al. Diagnostic accuracy of capsule endoscopy for small bowel Crohn's disease is superior to that of MR enterography or CT enterography. Clin Gastroenterol Hepatol 9 : 124-129, 2011

11）Solem CA, Loftus EV Jr, Fletcher JG, et al. Small-bowel imaging in Crohn's disease : a prospective, blinded, 4-way comparison trial. Gastrointest Endosc 68 : 255-266, 2008

12）Pasha SF, Leighton JA, Das A, et al. Double-balloon enteroscopy and capsule endoscopy have comparable diagnostic yield in small-bowel disease : a meta-analysis. Clin Gastroenterol Hepatol 6 : 671-676, 2008

13）Mary JY, Modigliani R. Development and validation of an endoscopic index of the severity for Crohn's disease : a prospective multicentre study. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif（GETAID）. Gut 30 : 983-989, 1989

14）Gralnek IM, Defranchis R, Seidman E, et al. Development of a capsule endoscopy scoring index for small bowel mucosal inflammatory change. Aliment Pharmacol Ther 27 : 146-154, 2008

15）Gal E, Geller A, Fraser G, et al. Assessment and validation of the new capsule endoscopy Crohn's disease activity index（CECDAI）. Dig Dis Sci 53 : 1933-1937, 2008