小腸出血性疾患の内視鏡診断―カプセル内視鏡とダブルバルーン内視鏡の役割

Endoscopic Diagnosis for Hemorrhagic Diseases of the Small Intestine: The Roles of Capsule Endoscopy and Double Balloon Endoscopy

要旨　カプセル内視鏡とダブルバルーン内視鏡の小腸出血性疾患の診断における現状と課題について概説した．小腸出血性疾患の診断に両者は非常に有用である．事前のカプセル内視鏡検査の有無によって，ダブルバルーン内視鏡の診断率に有意な差を認めないことから，両者を常に組み合わせて行う必要はないかもしれない．カプセル内視鏡単独での所見陰性とするには疑問があり，ダブルバルーン内視鏡による検査を追加し，現状における“真の陰性”を評価する必要がある．原因不明の消化管出血を認めながら小腸に病変を発見できない症例も経験され，これら症例の詳細を明るみにすることが今後の課題である．

　The current status and factors were outlined about capsule endoscopy and double balloon endoscopy for diagnosis of hemorrhagic diseases of the small intestine. Both modalities are very useful for diagnosis of these diseases. According to our experiences, the rate of positive diagnosis using double balloon endoscopy seems independent of whether or not it was preceded by capsule endoscopy, so using both endoscopies in all patients may not be necessary. However, when there is negative diagnosis based only on capsule endoscopy, there is always soon for suspicion that the negative diagnosis might be changed to a positive diagnosis if double balloon endoscopy is added. That is the reason why both modalities are used.

　Our experience also indicates that in cases where gastrointestinal bleeding (OGIB) of unknown origin is recognized, it is impossible to discover any pathological condition in the small intestine.

　It remains for future investigations to give more details concerning such cases.