Crohn病小腸病変の診断と経過―バルーン内視鏡の有用性と位置づけ─シングルバルーン内視鏡

Usefulness and Application of Single Balloon Endoscopy for Patients with Crohn's Disease

要旨　Crohn病患者に対するシングル・ダブルのバルーン小腸内視鏡は，挿入時の偶発症を避けるために慎重な内視鏡操作を必要とするものの，小腸病変の詳細な観察が可能となっている．また，小腸内視鏡で認められる病変の程度は，臨床的活動度（CDAI）と必ずしも一致しないことから，診断に用いられるだけでなく，今後内視鏡所見を加味した治療方針決定にも重要な役割を果たすと考えられる．さらに，内視鏡的バルーン拡張術は，開腹術と同等の効果が得られることが明らかとなり，腸管合併症の狭窄に対する治療法の1つとしてさらなる普及が期待されている．

　Single or double balloon endoscopy enables the detailed observation of small bowel lesions though Crohn's disease patients need careful endoscopic manipulation to avoid adverse events during insertion. It was proved that the endoscopic appearance of the small intestine did not always accord with clinical activities（CADI）. Therefore, balloon endoscopy should not only be used for the diagnosis but also should play an important role regarding treatment based on the degree of small intestinal lesions. In addition, endoscope balloon dilatation for intestinal stricture has been effective as well as stricture plasty under laparotomy, and is expected to be used widely as one of the treatments for intestinal strictures in future.