2) 食道

Important Points in Magnifying Endoscopic Diagnosis of Esophageal Diseases

要旨　食道は管腔が狭く，心拍動や呼吸性移動の影響を強く受ける．安定した状況で短時間に手際よく拡大観察するためには様々なコツがある．先端フードの装着は不可欠であるが，病変に押し付けたまま次の視野に移ったり，病変内で吸引したりするのは禁忌である．拡大率を先に決めたうえで，スコープの位置を細かく調節して焦点を合わせる．まずは中拡大程度で病変全体を観察し，気になる血管変化が捉えられたら，さらに拡大率を上げて観察する．強拡大ではトランペットに軽くタッチして送気し，病変とレンズとの間を取るようにする．病変の大きさの計測には，拡大時に観察される範囲をあらかじめ確認しておく必要がある．唾液を飲み込まないようにすることや規則的に呼吸をするなど，被検者の協力も欠かせない．

　The esophagus has a narrow lumen and is strongly influenced by heart beats and respiratory movements. Various techniques are available to promptly and efficiently perform magnifying endoscopy in stable conditions. A hood mounted on the tip of a scope is essential. However, moving to the next field of vision while pressing a lesion and during aspiration of a lesion must be avoided. The magnification rate is determined, and then the position of the scope is carefully adjusted to focus on the lesion. First, the entire lesion is observed under moderate-power magnification, and suspicious vascular changes are observed under higher-power magnification. At high-power magnification, a trumpet is gently touched to insufflate air and provide sufficient space between the lesion and lens. By measuring the size of lesions, the extent of the field that can be observed by magnifying endoscopy should be determined. Patients' cooperation, such as not swallowing saliva and breathing regularly, is also needed.