食道“dysplasia”の内視鏡観察―内視鏡でみている“dysplasia”とは

Endoscopic Characterization of Esophageal Dysplasia

要旨　食道“dysplasia”は通常の内視鏡観察では認められず，ヨード染色を行うと不染あるいは淡染域として認められる病変である．まれには白色調の軽度隆起や淡い発赤を示すものもある．ヨードの染色性により異型度を測定することがある程度可能でsevere dysplasiaは白色の不染域となり，moderateあるいはmild dysplasiaでは淡染域となる．mildあるいはmoderate dysplasiaでは点状線状に染色される部分を混じているものもある．dysplasiaを発見したら注意深い経過観察を行って，増大するものや内視鏡所見の進行するものについては内視鏡的粘膜切除術を行って治療を兼ねて診断を確定するのがよいと考える．

　Esophageal dysplasia which is not detected by conventional endoscopic examination is recognized only by iodine staining exhibiting as an unstained or faintly stained area. Some dysplastic lesions can be seen as a slightly elevated white area or faintly reddish one. It is possible to estimate the severity of dysplasia based on the degree of iodine staining. Severe dysplasia is shown as a white area with a clear margin and moderate or mild dysplasia as faintly stained area with spotty or linear brown segments. When dysplastic lesions are discovered in the esophagus, meticulous follow-up endoscopy with iodine staining should be performed. For the lesions which have increased in size or in severity, an endoscopic mucosectomy should be performed to make a correct diagnosis leading to an adequate treatment.