Crohn病に対する小腸内視鏡の有用性

Usefulness of Videocapsule Endoscopy and Double Balloon Endoscopy for Small-bowel Crohn's Disease

要旨　今回，小腸型Crohn病4例にカプセル内視鏡を行い，その有用性，全小腸観察能，滞留率を検討した．さらに，小腸型・小腸大腸型Crohn病28例にダブルバルーン内視鏡を施行し，診断・治療における有用性を検討した．カプセル内視鏡施行全例でCrohn病を示唆する病変が認められたが，肓腸到達率，小腸内滞留率は25％であった．ダブルバルーン内視鏡では96％に小腸病変が詳細に観察できた．小腸狭窄を呈した11例に単回および複数回のダブルバルーン内視鏡下バルーン拡張術を施行し，現在まで8例（73％）で手術が回避されている．今後，ダブルバルーン内視鏡下バルーン拡張術は小腸狭窄に対して外科手術前に考慮すべき治療法になりうると考えられる．

　Videocapsule endoscopy (VCE) and double balloon endoscopy (DBE) are breakthrough methods for endoscopic examination of the small bowel. In this study, 4 cases with Crohn's ileitis underwent VCE and 28 cases with Crohn's ileitis underwent DBE. VCE revealed typical Crohn's lesions in all cases but capsule retention occurred in one case and failure to enter the colon during the 8-h acquisition time occurred in three cases. DBE revealed typical Crohn's lesions in 96％ of cases. Balloon dilation procedures during DBE were performed in 11 cases with small-bowel Crohn's strictures. Of the 11 cases, eight recovered due to single or repeat balloon dilation but three required surgery. In a selected group of patients with Crohn's strictures, balloon dilation is considered to be an alternative to surgery.