胃と腸54巻2号

2019年02月発行

今月の主題 胃・十二指腸内視鏡拡大観察の基本と最新知見 主題

慢性胃炎粘膜（腸上皮化生）の拡大内視鏡所見

著者： 大森正泰¹ 上堂文也¹ 中川健太郎¹ 岩上裕吉¹ 松野健司¹ 井上俊太郎¹ 岩坪太郎¹ 中平博子¹ 松浦倫子¹ 七條智聖¹ 前川聡¹ 金坂卓¹ 山本幸子¹ 竹内洋司¹ 東野晃治¹ 石原立¹

所属機関： ¹大阪国際がんセンター消化管内科

ページ範囲：P.181 - P.190

要旨●慢性胃炎や腸上皮化生の存在診断は胃癌のリスク層別化に重要である．また，胃癌を疑う病変の鑑別診断や癌の境界診断にかかわる背景粘膜の所見としても重要である．拡大観察により視認可能となる微小血管や微細表面構造に着目した胃炎分類が多数報告されている．Helicobacter pylori感染のない正常な胃底腺粘膜はfoveola typeの構造が観察されるが，萎縮・腸上皮化生が高度な慢性胃炎粘膜ではgroove typeの粘膜を認めるようになる．また腸上皮化生のNBI併用拡大観察ではLBC，WOS，marginal turbid band，ridge/villous patternなどの知見が報告されている．

参考文献

1）Sakaki N, Iida Y, Okazaki Y, et al. Magnifying endoscopic observation of the gastric mucosa, particularly in patients with atrophic gastritis. Endoscopy　10：269-274, 1978

2）榊信広，飯田洋三，斎藤満，他．胃粘膜微細模様の新しい拡大内視鏡分類．日消誌　22：377-383, 1980

3）Nakagawa S, Kato M, Shimizu Y, et al. Relationship between histopathologic gastritis and mucosal microvascularity：observations with magnifying endoscopy. Gastrointest Endosc　58：71-75, 2003

4）Yagi K, Nakamura A, Sekine A. Characteristic endoscopic and magnified endoscopic findings in the normal stomach without Helicobacter pylori infection. J Gastroenterol Hepatol　17：39-45, 2002

5）Kim S, Ito M, Haruma K, et al. Surface structure of antral gastric mucosa represents the status of histologic gastritis：fundamental evidence for the evaluation of antral gastritis by magnifying endoscopy. J Gastroenterol Hepatol　21：837-841, 2006

6）Kim S, Harum K, Ito M, et al. Magnifying gastroendoscopy for diagnosis of histologic gastritis in the gastric antrum. Dig Liver Dis　36：286-291, 2004

7）Yagi K, Honda H, Yang JM, et al. Magnifying endoscopy in gastritis of the corpus. Endoscopy　37：660-666, 2005

8）八木一芳，渡辺順，中村厚夫，他．Helicobacter pylori感染胃粘膜の拡大内視鏡観察．胃と腸　42：697-704, 2007

9）Yang JM, Chen L, Fan YL, et al. Endoscopic patterns of gastric mucosa and its clinicopathological significance. World J Gastroenterol　9：2552-2556, 2003

10）Anagnostopoulos GK, Yao K, Kaye P, et al. High-resolution magnification endoscopy can reliably identify normal gastric mucosa, Helicobacter pylori-associated gastritis, and gastric atrophy. Endoscopy　39：202-207, 2007

11）Gonen C, Simsek I, Sarioglu S, et al. Comparison of high resolution magnifying endoscopy and standard videoendoscopy for the diagnosis of Helicobacter pylori gastritis in routine clinical practice：a prospective study. Helicobacter　14：12-21, 2009

12）Tahara T, Shibata T, Nakamura M, et al. Gastric mucosal pattern by using magnifying narrow-band imaging endoscopy clearly distinguishes histological and serological severity of chronic gastritis. Gastrointest Endosc　70：246-253, 2009

13）Kawamura M, Sekine H, Abe S, et al. Clinical significance of white gastric crypt openings observed via magnifying endoscopy. World J Gastroenterol　19：9392-9398, 2013

14）Liu H, Wu J, Lin XC, et al. Evaluating the diagnoses of gastric antral lesions using magnifying endoscopy with narrow-band imaging in a Chinese population. Dig Dis Sci　59：1513-1519, 2014

15）Bansal A, Ulusarac O, Mathur S, et al. Correlation between narrow band imaging and nonneoplastic gastric pathology：a pilot feasibility trial. Gastrointest Endosc　67：210-216, 2008

16）Kawamura M, Abe S, Oikawa K, et al. Topographic differences in gastric micromucosal patterns observed by magnifying endoscopy with narrow band imaging. J Gastroenterol Hepatol　26：477-483, 2011

17）Kanzaki H, Uedo N, Ishihara R, et al. Comprehensive investigation of areae gastricae pattern in gastric corpus using magnifying narrow band imaging endoscopy in patients with chronic atrophic fundic gastritis. Helicobacter　17：224-231, 2012

18）Yamasaki Y, Uedo N, Kanzaki H, et al. Investigation of mucosal pattern of gastric antrum using magnifying narrow-band imaging in patients with chronic atrophic fundic gastritis. Ann Gastroenterol　30：302-308, 2017

19）Qi QQ, Zuo XL, Li CQ, et al. High-definition magnifying endoscopy with i-scan in the diagnosis of Helicobacter pylori infection：a pilot study. J Dig Dis　14：579-586, 2013

20）Dohi O, Yagi N, Onozawa Y, et al. Linked color imaging improves endoscopic diagnosis of active Helicobacter pylori infection. Endosc Int Open　4：E800-805, 2016

21）Chen TH, Hsu CM, Cheng HT, et al. Linked color imaging can help gastric Helicobacter pylori infection diagnosis during endoscopy. J Chin Med Assoc　2018 May 16 ［Epub ahead of print］

22）Okubo M, Tahara T, Shibata T, et al. Changes in gastric mucosal patterns seen by magnifying NBI during H. pylori eradication. J Gastroenterol　46：175-182, 2011

23）Yagi K, Saka A, Nozawa Y, et al. Prediction of Helicobacter pylori status by conventional endoscopy, narrow-band imaging magnifying endoscopy in stomach after endoscopic resection of gastric cancer. Helicobacter　19：111-115, 2014

24）Tanaka K, Toyoda H, Kadowaki S, et al. Features of early gastric cancer and gastric adenoma by enhanced-magnification endoscopy. J Gastroenterol　41：332-338, 2006

25）Dinis-Ribeiro M, da Costa-Pereira A, Lopes C, et al. Magnification chromoendoscopy for the diagnosis of gastric intestinal metaplasia and dysplasia. Gastrointest Endosc　57：498-504, 2003

26）Areia M, Amaro P, Dinis-Ribeiro M, et al. External validation of a classification for methylene blue magnification chromoendoscopy in premalignant gastric lesions. Gastrointest Endosc　67：1011-1018, 2008

27）Baczewska-Mazurkiewicz D, Rydzewska G, Milewski J, et al.Magnification chromoendoscopy in comparison to standard chromoendoscopy for detection of intestinal metaplasia in renal transplant recipients. Adv Med Sci　51：115-118, 2006

28）Song J, Zhang J, Wang J, et al. Meta-analysis：narrow band imaging for diagnosis of gastric intestinal metaplasia. PLoS One　9：e94869, 2014

29）Ang TL, Fock KM, Teo EK, et al. The diagnostic utility of narrow band imaging magnifying endoscopy in clinical practice in a population with intermediate gastric cancer risk. Eur J Gastroenterol Hepatol　24：362-367, 2012

30）Lage J, Pimentel-Nunes P, Figueiredo PC, et al. Light-NBI to identify high-risk phenotypes for gastric adenocarcinoma：do we still need biopsies? Scand J Gastroenterol　51：501-506, 2016

31）Dutta AK, Sajith KG, Pulimood AB, et al. Narrow band imaging versus white light gastroscopy in detecting potentially premalignant gastric lesions：a randomized prospective crossover study. Indian J Gastroenterol　32：37-42, 2013

32）Uedo N, Ishihara R, Iishi H, et al. A new method of diagnosing gastric intestinal metaplasia：narrow-band imaging with magnifying endoscopy. Endoscopy　38：819-824, 2006

33）Savarino E, Corbo M, Dulbecco P, et al. Narrow-band imaging with magnifying endoscopy is accurate for detecting gastric intestinal metaplasia. World J Gastroenterol　19：2668-2675, 2013

34）Rerknimitr R, Imraporn B, Klaikeaw N, et al. Non-sequential narrow band imaging for targeted biopsy and monitoring of gastric intestinal metaplasia. World J Gastroenterol　17：1336-1342, 2011

35）Wang L, Huang W, Du J, et al. Diagnostic yield of the light blue crest sign in gastric intestinal metaplasia：a meta-analysis. PLoS One　9：e92874, 2014

36）Yao K, Iwashita A, Nambu M, et al. Nature of white opaque substance in gastric epithelial neoplasia as visualized by magnifying endoscopy with narrow-band imaging. Digestive Endoscopy　24：419-425, 2012

37）Matsushita M, Mori S, Uchida K, et al. “White opaque substance” and “light blue crest” within gastric flat tumors or intestinal metaplasia：same or different signs? Gastrointest Endosc　70：402, 2009

38）Kanemitsu T, Yao K, Nagahama T, et al. Extending magnifying NBI diagnosis of intestinal metaplasia in the stomach：the white opaque substance marker. Endoscopy　49：529-535, 2017

39）Togo K, Ueo T, Yao K, et al. White opaque substance visualized by magnifying narrow-band imaging is associated with intragastric acid conditions. Endosc Int Open　6：E830-837, 2018

40）Saka A, Yagi K, Nimura S. OLGA- and OLGIM-based staging of gastritis using narrow-band imaging magnifying endoscopy. Dig Endosc　27：734-741, 2015

41）An JK, Song GA, Kim GH, et al. Marginal turbid band and light blue crest, signs observed in magnifying narrow-band imaging endoscopy, are indicative of gastric intestinal metaplasia. BMC Gastroenterol　12：169, 2012

42）Okubo M, Tahara T, Shibata T, et al. Light blue crest and ridge/villous patterns in the uninvolved gastric antrum by magnifying NBI endoscopy correlate with serum pepsinogen and gastric cancer occurrence. Hepatogastroenterology　61：525-528, 2014

43）Pimentel-Nunes P, Dinis-Ribeiro M, Soares JB, et al. A multicenter validation of an endoscopic classification with narrow band imaging for gastric precancerous and cancerous lesions. Endoscopy　44：236-246, 2012

44）Sobrino-Cossío S, Abdo Francis JM, Emura F, et al. Efficacy of narrow-band imaging for detecting intestinal metaplasia in adult patients with symptoms of dyspepsia. Rev Gastroenterol Mex　83：245-252, 2018

45）So J, Rajnakova A, Chan YH, et al. Endoscopic tri-modal imaging improves detection of gastric intestinal metaplasia among a high-risk patient population in Singapore. Dig Dis Sci　58：3566-3575, 2013

46）Shi J, Jin N, Li Y, et al. Clinical study of autofluorescence imaging combined with narrow band imaging in diagnosing early gastric cancer and precancerous lesions. J BUON　20：1215-1222, 2015

47）Chen H, Liu Y, Lu Y, et al. Ability of blue laser imaging with magnifying endoscopy for the diagnosis of gastric intestinal metaplasia. Lasers Med Sci　33：1757-1762, 2018 ［Epub ahead of print］

48）Hamada K, Itoh T, Kawaura K, et al. Findings of the margin around lesions by magnifying endoscopy with narrow-band imaging in early gastric carcinoma and intestinal metaplasia. J Dig Dis　17：377-382, 2016

49）Kanesaka T, Uedo N, Yao K et al. Multiple convex demarcation line for prediction of benign depressed gastric lesions in magnifying narrow-band imaging. Endosc Int Open　6：E145-155, 2018

50）八尾建史，中村守，長浜孝，他．拡大内視鏡による癌の進展範囲診断．胃と腸　42：735-745, 2007