1) 咽頭・食道

Magnifying Endoscopic Findings in the Pharynx and Esophagus―Observation of IPCL and Cellular Structure

要旨　一般的に拡大観察には，①通常拡大観察（約80倍）と②超・拡大観察（約450倍～1,100倍）がある．咽頭・食道の扁平上皮領域の拡大観察においては，①の通常拡大観察（約80倍）では上皮の乳頭内ループ状血管（intra-epithelial papillary capillary loop；IPCL）が観察される．通常光では毛細血管ループそのものが観察され，それがNBIでは褐色に強調される．②の超・拡大観察（endocytoscopy，プロトタイプ）では細胞観察が可能である．メチレンブルー染色により扁平上皮の細胞と細胞核が観察される．さらに二重染色（クリスタルバイオレット＋メチレンブルー）を行うことにより，HE染色に匹敵する画像も描出される．これらの正常所見の理解は，内視鏡的異型度診断〔「4.拡大内視鏡による分類　1」食道①」に後述〕の基本となるので，併せてご理解されたい．

　Magnification endoscopy involves two categories. Standard magnifying endoscopy has approximately 80-fold magnification power which enables the observation of IPCL (intra-epithelial papillary capillary loop) in the pharynx and esophagus. IPCL is further emphasized with NBI imaging technology. Another category is ultra-high magnification endoscopy with around 500-fold magnification which enables the observation of cellular-level structures by contacting the target tissue surface. It is called endocytoscopy. In endocytoscopy, the cell nucleus is well demonstrated by staining with methylene blue. A newly developed double-staining technique also enables the observation of cellular structure as a well-contrasted image which is similar to that prodused by Hematoxylin & Eosin staining.

　The magnifying observations mentioned above hare already been enrolled as a part of regular endoscopic observation.