Barrett食道癌の内視鏡診断―拡大内視鏡を併用した深達度診断

Usefulness of NBI-Magnification Endoscopy in the Determination of the Depth of Invasion of Barrett's Esophageal Cancer

要旨　表在型Barrett食道癌12例に対して，NBI拡大内視鏡を用い，calibervariation（CV）の出現の有無を検討した．さらに，免疫組織学的に粘膜表層のSMA陽性血管の出現とVEGFの発現有無を検討した．SM癌4例は全例CVがNBI拡大内視鏡で観察できた．4例とも免疫組織学的検討では粘膜表層にSMA陽性の血管平滑筋を伴った血管が出現し，VEGF陽性であった．M癌8例（SMM 7例，DMM 1例）中2例がCV陽性であり，深達度はDMM 1例，SMM 1例であった．免疫組織学的にはM癌において粘膜表層のSMA陽性血管の出現は3例にみられた．M癌ではVEGF陽性例は2例あり，1例はCV陽性例であった．Barrett食道癌においてもCVの出現はSM癌を示唆する所見となりうる可能性があると考えられた．

　Development of CV（caliber variation）was examined by magnifying endoscopy with NBI in 12cases with superficial-type esophageal cancer. In addition, development of SMA-positive blood vessels in the superficial layer of the mucosa and VEGF expression were examined immunohistochemically. CV was observed by magnifying endoscopy with NBI in all four cases with SM cancer. Immunohistochemistry revealed development of blood vessels with SMA-positive vascular smooth muscle in the superficial layer of the mucosa and VEGF was positive in all these cases. CV was detected in 2 of 8 M cancer cases（SMM, 7 ; DMM, 1）and invasion depth in DMM and SMA. SMA-positive blood vessels were observed immunohistochemically in the superficial layer of the mucosa in three cases with M cancer. VEGF was positive in two cases with M cancer and CV was detected in one case. These results revealed the possibility that development of CV is a finding suggestive of SM cancer in cases with Barrett's esophageal cancer. .