3)大腸

Etiology, Diagnosis, and Management for Complications during and after Therapeutic Colonoscopy

要旨　日本消化器内視鏡学会の第4回全国調査（1998～2002年）によれば，大腸内視鏡に伴う偶発症の頻度は0.069％であり，その90％以上が出血と穿孔であると報告されている．また，広島消化器内視鏡治療研究会のアンケート集計（1994～1999年）によれば，出血は大腸内視鏡治療の1.37％に発生し，手技別検討ではEMR2.46％，ポリペクトミー1.52％，ホットバイオプシー0.47％であり，穿孔は大腸内視鏡治療の0.02％に発生し，手技別検討ではEMR0.06％，ポリペクトミー0.02％であった，と報告されている．偶発症はすべての内視鏡医が遭遇しうるものであり，われわれ内視鏡医は，そのメカニズムを理解し，事前に偶発症を最小限に抑える対策を講じ，偶発症発生時に適切な対処を行う術を身につけておく必要がある．

　According to the 4th nation-wide questionnaire by the Japan Gatroenterological Endoscopy Society (1998-2002), the frequency of complications associated with colonoscopy was 0.069％ and, of those, more than 90％ were the complications of bleeding or perforation. Another region-wide questionnaire in Hiroshima (1994-1999) revealed that the frequency of bleeding and perforation were 1.37％ and 0.02％, respectively. The sub-analyses according to the therapeutic methods used showed that the frequencies in EMR, polypectomy, and hot biopsy were 2.46％ and 0.06％, 1.52％ and 0.02％, and, 0.47％ and 0％, respectively. Complications are encountered by all endoscopists by chance, which shows the necessity for them to understand the underlying mechanisms of the bleeding, to minimize the risk of complications, and to cope with complications in appropriate ways.