出血性小腸疾患に対する診断手技―小腸X線造影検査について

Obscure Gastrointestinal Bleeding : the Role of Small-Bowel Radiography

要旨　小腸内視鏡検査と小腸X線造影検査を併用実施した非顕性小腸出血例を抽出，提示して，小腸X線造影検査の有用性を考察した．NSAID起因性潰瘍2例は，ともに微小な多発性潰瘍性病変の形態を呈し，バルーン内視鏡検査（BE）で発見されたが，経口X線造影検査（圧迫法）で描出可能であり，小腸X線造影検査はNSAIDの使用中止後の評価，経過観察に有用と考えた．また管外性発育型GIST 2例は，存在診断と質的診断の両面においてゾンデ法X線造影検査が有用であった．出血性小腸疾患の初期診断におけるカプセル内視鏡（VCE）とBEの有用性に疑いの余地はないが，待機的に対応可能な非顕性出血例の診断においては，従来のX線造影検査と内視鏡検査を併用実施することにより診断能が向上する可能性がある．

　Four patients with obscure gastrointestinal bleeding underwent both radiography and small-bowel endoscopy, including balloon enteroscopy and video-capsule endoscopy. In the two patients with NSAID-induced small intestinal ulcerations, radiography was able to identify the lesions detected by balloon endoscopy. In another two patients with gastrointestinal stromal tumor, a complementary combination between the radiography and balloon endoscopy seemed to be useful for the diagnosis. While balloon endoscopy and capsule endoscopy are increasingly being used to investigate the small bowel for various indications, including obscure gastrointestinal bleeding, radiography may also be performed as a first-line examination in patients having occult blood stool without overt gastrointestinal bleeding.