Crohn病小腸病変に対する治療効果―内視鏡的狭窄拡張術の適応と臨床効果

Indication and Clinical Efficacy of Endoscopic Balloon Dilation Therapy for Small Intestinal Strictures in Patients with Crohn's Disease

要旨　Crohn病（CD）の小腸狭窄に対する内視鏡的拡張療法（EBD）の方法，当科での治療成績と安全性について概説した．当科ではダブルバルーン小腸内視鏡（DBE）を用いてEBDを行っているが，CDの小腸狭窄へのEBDの適応は（1）閉塞症状を伴う小腸狭窄で，（2）狭窄長が3cm以下，（3）狭窄部に瘻孔や膿瘍のないもの，（4）狭窄部に深い潰瘍のないもの，（5）病変による強い屈曲がないものとしている．初回EBDから6か月以上経過した25例の解析では，短期成功率は72％，12か月後の累積手術回避率は72％であった．合併症は2例（8％）で認めたが，いずれも保存的治療にて改善し，外科的手術を要する穿孔などの重篤な合併症はなかった．当科では小腸狭窄を有するCD患者の臨床経過とQOLを改善しうるという観点から，DBEを用いたEBDを積極的に行っている．今後，多数例での長期成績の検討やさらなる安全性の向上が望まれる．

　We described the method and outcome and safety features of endoscopic balloon dilation therapy（EBD）for small intestinal strictures in Crohn's disease（CD）using double- balloon endoscopy（DBE）in our hospital.

　Indications for EBD for small intestinal strictures in CD with DBE in our hospital are as follows : 1）small bowel strictures causing obstructive symptoms, 2）those whose length is less than 3cm, 3）those without fistula or abscess, 4）those without deep ulcer, 5）those without severe kinking .

　Short-term success over 6 months from the initial EBD was attained in 18 out of 25 patients（72％）, and the cumulative surgery-free rate was 72％ at 12 months after the initial EBD.

　Complications occurred in 2 out of 25 patients（8％）, both of whom were able to be cured, using conservative therapy. There were no serious complications such as perforation which needed surgery.

　Because EBD using DBE has the potential to improve the clinical course and QOL of CD patients with small intestinal strictures, we have actively undertaken EBD using DBE.

　It is necessary to observe a much larger number of patients for a longer period to comfirm the validity of this treatment method and to improve the safety of EBD.