Barrett食道癌の内視鏡診断―IEEを用いた拾い上げ診断のポイント

The Diagnosis of Barrett's Esophageal Cancer by Image Enhanced Endoscopy（IEE）

要旨　当院の9例のBarrett癌を対象に癌の好発部位と，IEEとしてインジゴカルミン撒布，白色光およびNBI拡大観察，酢酸撒布法による内視鏡像を検討した．癌の好発部位はSCJ直下でSSBEでは0～2時，LSBEでは6～10時であった．その部位の色調変化で癌を疑った場合，インジゴカルミン，白色光またはNBI拡大で胃癌に準じた診断を行う．NBIからの情報では診断困難な場合は酢酸エンハンス拡大観察で腺管構造に癌特有な像があるか観察し，形態学的観察で鑑別が困難な場合は酢酸ダイナミック・ケミカル法で白色化の早期消失部を癌と考える手順が効率的と考えられた．

　The location and images of IEE in 9 Barrett's cancer cases were evaluated. 8 lesions developed directly distal to the site of squamo-columnar junction（SCJ）and 7 lesions of the 8 arose from SSBE developed in the 12 to 2 o'clock direction. The micro-vessels pattern was important for diagnosis of cancer by magnifying endoscopy with NBI. Under magnifying endoscopy with acetic-acid enhancement, the structure of cancerous epithelium became clear. For this lesion whose diagnosis is difficult by the morphologic method, micro-vessels and structure, and acetic-acid dynamic chemical endoscopy was practical. As the whitening of the cancerous area disappeared quickly compared to that of the non-cancerous area, the clear contrast between cancerous area and non-cancerous area could be observed.