胃と腸59巻6号

2024年06月発行

今月の主題 内視鏡治療後サーベイランスの現状—異時性多発病変を中心に

主題研究

小腸腫瘍の内視鏡治療後サーベイランス

著者： 壷井章克¹ 重信修宇也¹ 松原由佳¹ 平田一成¹ 岡志郎¹

所属機関： ¹広島大学病院消化器内科

ページ範囲：P.869 - P.876

文献概要

要旨●近年カプセル内視鏡やバルーン内視鏡などの小腸内視鏡が広く普及したことにより，小腸腫瘍の診断が容易になった．しかし，小腸腫瘍に対する内視鏡治療の適応や治療後のサーベイランスについては，十分なコンセンサスはない．小腸腫瘍の種類は多岐にわたるが，消化管ポリポーシス合併の小腸病変は生涯にわたりサーベイランスが必要である．その際，小腸内視鏡のみならず，従来の体外式超音波検査，X線造影検査，造影CTなど他の診断法の特性を十分に理解したうえで適切なサーベイランスを行う必要がある．

参考文献

1）山本博徳，阿部孝，石黒信吾，他．小児・成人のためのPeutz-Jeghers症候群診療ガイドライン（2020年版）．遺伝性腫瘍　20：59-78, 2020

2）Khurelbaatar T, Sakamoto H, Yano T, et al. Endoscopic ischemic polypectomy for small-bowel polyps in patients with Peutz-Jeghers syndrome. Endoscopy　53：744-748, 2021

3）Limpias Kamiya KJL, Hosoe N, Takabayashi K, et al. Feasibility and safety of endoscopic ischemic polypectomy and clinical outcomes in patients with Peutz-Jeghers syndrome（with video）. Dig Dis Sci　68：252-258, 2023

4）三井啓吾，岩切勝彦．良性腫瘍—総論（疫学他）．日臨　80：131-135, 2022

5）壷井章克，岡志郎，松原由佳，他．原発性小腸癌の臨床病理学的特徴—内視鏡診断を中心に．胃と腸　57：783-792, 2022

6）Cortegoso Valdivia P, Deding U, Bjørsum-Meyer T, et al. Surveillance of the small-bowel by capsule endoscopy in Lynch syndrome−A systematic review with meta-analysis. Dig Liver Dis　56：601-606, 2024

7）山本博徳，緒方晴彦，松本主之，他．小腸内視鏡ガイドライン，Gastroenterol Endosc　57：2685-2720, 2015

8）Pennazio M, Rondonotti E, Despott EJ, et al. Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders：European Society of Gastrointestinal Endoscopy（ESGE）Guideline - Update 2022. Endoscopy　55：58-95, 2023

9）Mitsui K, Tanaka S, Yamamoto H, et al. Role of double-balloon endoscopy in the diagnosis of small-bowel tumors：the first Japanese multicenter study. Gastrointest Endosc　70：498-504, 2009

10）Honda W, Ohmiya N, Hirooka Y, et al. Enteroscopic and radiologic diagnoses, treatment, and prognoses of small-bowel tumors. Gastrointest Endosc　76：344-354, 2012

11）Ohmiya N, Nakamura M, Tahara T, et al. Management of small-bowel polyps at double-balloon enteroscopy. Ann Transl Med　2：30, 2014

12）Cheung DY, Lee IS, Chang DK, et al. Capsule endoscopy in small bowel tumors：a multicenter Korean study. J Gastroenterol Hepatol　25：1079-1086, 2010

13）Islam RS, Leighton JA, Pasha SF. Evaluation and management of small-bowel tumors in the era of deep enteroscopy. Gastrointest Endosc　79：732-740, 2014

14）Tsuboi A, Oka S, Tanaka S, et al. The Clinical Usefulness of the PillCam Progress Indicator for route selection in double balloon endoscopy. Intern Med　58：1375-1381, 2019

15）Hirata I, Tsuboi A, Oka S, et al. Diagnostic yield of proximal jejunal lesions with third-generation capsule endoscopy. DEN Open　3：e134, 2022

16）Ohmiya N, Nakamura M, Takenaka H, et al. Management of small-bowel polyps in Peutz-Jeghers syndrome by using enteroclysis, double-balloon enteroscopy, and videocapsule endoscopy. Gastrointest Endosc　72：1209-1216, 2010

17）Ohmiya N, Oka S, Nakayama Y, et al. Safety and efficacy of the endoscopic delivery of capsule endoscopes in adult and pediatric patients：Multicenter Japanese study（AdvanCE-J study）. Dig Endosc　34：543-552, 2022

18）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

19）Urquhart P, Grimpen F, Lim GJ, et al. Capsule endoscopy versus magnetic resonance enterography for the detection of small bowel polyps in Peutz-Jeghers syndrome. Fam Cancer.　13：249-255, 2014

20）Wagner A, Aretz S, Auranen A, et al. The management of Peutz-Jeghers syndrome：European Hereditary Tumour Group（EHTG）guideline. J Clin Med　10：473, 2021

21）Boland CR, Idos GE, Durno C, et al. Diagnosis and management of cancer risk in the gastrointestinal hamartomatous polyposis syndromes：recommendations from the US Multi-Society Task Force on colorectal cancer. Am J Gastroenterol　117：846-864, 2022

22）Syngal S, Brand RE, Church JM, et al. ACG clinical guideline：genetic testing and management of hereditary gastrointestinal cancer syndromes. Am J Gastroenterol　110：223-262, quiz 263, 2015

23）van Lier MG, Mathus-Vliegen EM, Wagner A, et al. High cumulative risk of intussusception in patients with Peutz-Jeghers syndrome：time to update surveillance guidelines? Am J Gastroenterol　106：940-945, 2011

24）Ishida H, Tajima Y, Gonda T, et al. Update on our investigation of malignant tumors associated with Peutz-Jeghers syndrome in Japan. Surg Today　46：1231-1242, 2016