2) カプセル内視鏡検査

Video Capsule Endoscopy

要旨　カプセル内視鏡は2000年以降，欧米を中心に小腸疾患に対し広く用いられており，本邦においても2007年10月から保険収載された．Olympus Medical System社製の国産新型カプセル内視鏡は現在認可申請中であるが，その特徴は画像解像度の向上，光量の自動調節機能ならびに携帯型のreal-time viewerである．小腸X線造影検査に比し有意に病変発見率が高く，とりわけ血管性病変に対して高い有効性が示されている．またreal-time viewerの機能を利用し，カプセルの胃からの排泄遅延を認めた場合にはmetoclopramideの投与を行うことで，より効率的で良好な小腸の観察が可能になった．バルーン付小腸内視鏡との併用により，これまでは困難とされていた小腸疾患に対する診断・治療に大きく貢献するものと思われる．

　Video capsule endoscopy (VCE) is a major advance in visualization of the small intestine and has been widely used against small intestinal involvement mainly in the United States and Europe, since 2000. A new capsule endoscope developed by Olympus Medical Systems provides upgraded resolution, depth of field, and brightness of the image, by improving the optical system, combined with the new function of adjusting the level of lighting automatically, according to the surrounding brightness and the original handy real-time viewer display. Clinical trial using this capsule demonstrated a significantly higher diagnostic yield compared with barium contrast radiography of the small bowel, especially for vascular involvement. The real-time viewer could be useful for detecting gastric transit abnormality as well as for increasing the likelihood of a complete small-bowel examination with metoclopramide administration. Together with balloon-equipped enteroscopy, VCE is a new device which contributes to the diagnosis and the treatment of small bowel lesions.