胃と腸51巻10号

2016年09月発行

今月の主題 表在型Barrett食道癌の診断

主題

表在型Barrett食道癌の内視鏡診断─拾い上げ診断

著者： 藤崎順子¹ 大前雅実¹ 清水智樹¹ 山崎明¹ 片岡星太¹ 吉水祥一¹ 大隅寛木¹ 堀内裕介¹ 由雄敏之¹ 平澤俊明¹ 石山晃世志¹ 山本頼正¹ 土田知宏¹ 五十嵐正広¹

所属機関： ¹がん研有明病院消化器内科

ページ範囲：P.1299 - P.1310

文献概要

要旨●表在型Barrett食道癌の拾い上げ診断について，通常内視鏡検査のWL（white light）による肉眼型，色調変化，平坦陥凹型ではNBI弱拡大所見，拡大所見を中心に検討した．また，背景がLSBE（long segment Barrett's esophagus），SSBE（short segment Barrett's esophagus）の違いについて言及した．検討症例はLSBE背景が21症例25病変，SSBEは85症例86病変で，計106症例111病変である．隆起型，平坦陥凹型に分けると，LSBEは14/25（56.0％），11/25（44.0％）で，SSBEは55/86（64.0％），31/86（36.0％）と，LSBEで平坦陥凹型の比率がやや高かったが，半数以上の症例が隆起型の形態を呈していた．平坦陥凹型のほとんどの症例で発赤調を呈し，さらにNBIでLSBE 10/11（91.0％），SSBE 27/31（87.1％）が茶色様変化を呈しており，認識が可能であった．したがって，平坦陥凹型病変の90％が発赤調を呈することを考慮すると，隆起型もしくは発赤，NBIで茶色様変化を認識することで106/111（95.5％）の症例は発見可能である．しかし，約5％の症例はWL，NBI弱拡大観察のみでは発見困難な症例があった．また，0-I＋IIb型，0-IIa＋IIc型など複合型の肉眼型をとる病変はLSBEに多く，LSBE 13/25（52.0％），SSBE 28/86（32.6％）であり，複合肉眼型のSM癌率，組織混合型率が多かった．また，0-IIb型もしくは随伴0-IIb型はLSBEで10/25（40.0％），SSBEで5/86（5.8％）とLSBEに多くみられた．病変の局在は，右前に存在する症例がLSBEでは9/25（36.0％），SSBEで63/86（73.3％）とSSBEで圧倒的に多くみられた．すなわち，SSBEでは右前の隆起もしくは発赤に注目することが重要である．LSBEでは分布が広く，発赤，NBIによる茶色様変化に注目していく必要がある．

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