食道粘膜の拡大観察―Barrett上皮・食道の粘膜性状診断：拡大内視鏡とNBI内視鏡を用いて

Magnifying Endoscopy Used to Show a Relationship between the Pit Pattern of Barrett's Mucosa and the Phenotype of Mucin

要旨　拡大内視鏡によりBarrett粘膜のpit patternは5型に分類可能であり，pit-4(管状型)ならびにpit-5(絨毛型)はpit-1(点状)，pit-2(直線状)に比べ，メチレンブルー染色陽性率が高く，免疫組織学的にも腸型ムチンを高頻度に認め，一方pit-1，pit-2は胃型ムチンを優位に発現し，pit-3(長楕円状)は両者の中間的パターンであり，ムチン形質発現とpit patternには関連性が認められた．さらにpit-4のKi-labeling indexはpit-1，pit-2と比較して有意に高値であった．Barrett粘膜のpit pattern分類はメチレンブルー吸収能，ムチン発現，細胞増殖能といったBarrett粘膜の生物学的な機能を反映していた．狭帯域フィルターを用いるNBI内視鏡はBarrett粘膜のpit patternをより明瞭に描出可能であった．

　Specialized columnar epithelium (SCE) in Barrett's esophagus has been detected by random or four quadrant biopsy using conventional endoscopy. However, little is known about the fine mucosal structure of SCE. The fine mucosal pattern (pit pattern) of 70 regions in Barrett's mucosa was recorded and compared, using magnifying endoscopy and methylene blue staining. Histological, mucin immunohistologic, and cell proliferation analyses of biopsy specimens were also performed in relation to the pit patterns obtained by magnifying endoscopy. Pit patterns were classified into five categories. Tubular or villous pit patterns were characteristics of SCE and had methylene blue absorption qualities. They also possessed intestinal mucin phenotype whose Ki-labeling index was high, while other pit patterns, dot or straight pattern, did not have SCE and were categorized as gastric phenotype mucosa. Long oval pit pattern had an intermediate phenotype between these two groups. Classification of superficial mucosal appearance obtained by magnifying endoscopy reflects not only histological features but also mucin phenotypes.