小さな小腸病変の診断と治療の進歩―治療機器の進歩とアルゴリズム

Diagnosis and Treatment of Small Lesions in the Small Bowel

要旨　深部小腸に直接到達できるダブルバルーン内視鏡が登場し，小さな小腸病変に対しても詳細な観察と内視鏡治療を行うことが可能となった．また，内視鏡先端のバルーンを排したシングルバルーン内視鏡も発売され，両者を合わせてバルーン内視鏡として普及が進んでいる．内視鏡の普及に合わせて周辺機器や処置具の開発も進んでおり，特にCO₂送気やAPC関連機器，胆道系処置具などに進化がみられる．また，従来は内視鏡が到達できないために，姑息的に経過をみるか，外科手術に頼らざるをえなかった小腸の小血管性病変や浸潤のない腫瘍性病変に対してダブルバルーン内視鏡での治療が可能となり，治療ストラテジーにも変化がみられている．

　With the development of double balloon endoscopy（DBE）, which can intubate the small intestine deeply, even small lesions can be observed and treated endoscopically. Recently, single balloon endoscopy（SBE） which has just one balloon on the tip of the overtube has also been developed. In addition to the spread of balloon endoscopy, peripherals and treatment tools, such as carbon dioxide（CO₂）insufflation system, and argon plasma coagulation（APC）probes for these endoscopes have also been developed.

　Moreover, therapeutic algorithms for various small intestinal diseases have been changed by the development of DBE. Small vascular lesions and non-invasive tumors, which have formerly been treated surgically or conservatively, can now be treated endoscopically.