拡大内視鏡の歴史

History of Magnifying Endoscopy

要旨　拡大内視鏡は実体顕微鏡の研究を基礎的背景として開発が進められた．1967年に消化器内視鏡を用いて胃粘膜を拡大観察するという目的で初めて拡大ファイバースコープが作製され，胃を対象にその後1977年ごろまで開発が続いた．最初の拡大大腸ファイバースコープは1975年に報告された．臨床的に大腸粘膜の拡大観察が注目されるようになったのは，1990年代に電子スコープが広く普及したことに加えて，微小癌や平坦・陥凹型早期癌が多く診断され，かつ治療されるようになってきたことによる．一方，近年，様々な進歩により胃の拡大観察も比較的容易になった．2000年から上部消化管汎用内視鏡と同じサイズと操作性を有し，最大倍率において十分な分解能と観察深度を有するスコープが開発され一般に使用できるようになった．食道，中・下咽頭領域の拡大観察については，特にnarrow band imaging（NBI）の併用により飛躍的に進歩している．

　The development of magnifying endoscopy has advanced against the basic background of stereomicroscopy research. In 1967, a gastrointestinal endoscope was used to produce the first magnifying fiberscope for the purpose of magnified observation in vivo, and the development continued thereafter until 1977, with the stomach as the subject. The first magnifying colonic fiberscope was reported in 1975. In addition to the widespread adoption of electronic endoscopes in the1990s, magnified clinical observation of the colorectal mucosa began to attract attention as a result of the diagnosis and treatment of many micro-cancers and flat and depressed-type early cancers. Magnified observation of the stomach, on the other hand, has also become relatively easy as a result of various advances in recent years. Since 2000, there has been development and general use of magnifying endoscopes that have the same size and maneuverability as general-purpose endoscopes for the upper gastrointestinal tract and that have adequate resolution and observation depth at their maximum magnification. Dramatic advances have been made in magnified observation of the esophagus and pharyngeal region, especially as a result of combined use with narrow-band imaging (NBI).