出血性小腸疾患の診断―血管性病変

Diagnosis of Hemorrhagic Small IntestinalDiseases Vascular Lesions

要旨　小腸の画像診断は，バルーン内視鏡やカプセル内視鏡の開発により飛躍的に向上した．それに伴い，小腸における血管性病変の実態が明らかになり，小腸出血における血管性病変の占める割合は最も高く，重要な疾患であることがわかってきた．血管性病変の診断には，検査時期・方法の選択が成功の鍵を握っているが，その判断は各施設の基準にゆだねられている．また内視鏡を用いて正確な診断を行い，病変に適した治療選択を行うために，病変の病理背景・種類・合併症・部位などの病態背景を知ることが必要である．今後さらなる症例の蓄積により，病態理解を深め，適切な診断・治療を確立する必要がある．

　Endoscopic diagnosis of small-intenstinal diseases has been improved dramatically by the development of balloon endoscopy and videocapsule endoscopy. These new modalities have also revealed that vascular lesions are the leading cause of small-intestinal bleeding. Although it is essential for diagnosis to select an appropriate method and timing in order to detect vascular lesions, the standardized criteria need to be agreed upon among medical facilities or guidelines. It is nessesary to understand the clinical features of vascular lesions such as types of lesion and frequently affected locations. It is important to accumulate cases and understand the pathophysiology of these diseases. Moreover, establishment of a diagnostic method and definitive treatment is required.