食道胃接合部腺癌のNBI拡大観察による診断

Diagnosis of Esophagogastric Junctional Cancer by NBI Magnified Endoscopy

要旨　食道胃接合部は内腔が狭く観察しにくいため，深吸気下での観察やupアングルと左右アングルを十分に使用する必要がある．食道胃接合部腺癌のNBI拡大観察では表面構造と血管構造に注目する．表面構造はpit様構造とvilli様構造に大別され，“不整化・癒合・大小不同・高密度”に注目して観察する．血管構造では“口径不同・走行不整・network pattern”を観察する．またSCJに接する病変の場合は扁平上皮下への進展がありうるため，口側境界に注意する必要がある．

　The diagnosis of Esophago gastric junctional cancer is difficult, because the cavity is narrow and inflammation is caused by gastric acid.

　Necessary for observation in the use of inhalation and exhalation, and the use of and right-and-left angle endoscopy.

　Attention must be paid to the surface and vascular patterns while using NBI magnified endoscopy to search for esophago gastric junctional cancer. There are some points that should be checked in the surface pattern, irregularity, fusion of pit-like pattern and villi-like pattern and density should be checked. And, there are some points to check for the differential diagnosis between cancer and inflammation in the vascular pattern, irregularity, running and fine network pattern.

　Attention must be paid to the oral margin because of the extension under the squamous epithelium.