3D-EUS―胃食道静脈瘤の3D-CD-EUS

Three-Dimensional Image of Color Doppler Endoscopic Ultrasonography (3D-CD-EUS) for Gastroesophageal Varices

要旨　カラードプラ機能を有するリニア走査型超音波内視鏡装置(CD-EUS)を用いて，われわれが行っている胃食道静脈瘤の血流検出率を示し，三次元表示あるいは疑似三次元表示について概説した．胃食道静脈瘤の血行動態を把握することは，内視鏡的治療やintervention治療などを行う際に，治療法の選択，効果の予測や判定に不可欠である．CD-EUSにより施行中にこれらの構築や血行動態を立体的に把握することが可能であり，また把握されなければ正確な診断は困難である．したがって，CD-EUSの三次元表示は客観的に病態を立体的に呈示するのに役立つものである．しかし，現時点でのCD-EUSの三次元あるいは疑似三次元表示は狭い範囲の表示にとどまるため，全体像を表示するには不十分であり，今後の発展が望まれる．

　The technology using color Doppler ultrasonography has been developing rapidly. We evaluated the recent technologies especially in three-dimensional expression or three-dimension-like expression of gastroesophageal varices using color Doppler endoscopic ultrasonography (CD-EUS) (TOSHIBA-MACHIDA: EPE-703FL and TOSHIBA-FUJINON: PEF-703FA). We also discussed the future of three-dimensional imaging in CD-EUS (3D-CD-EUS). The recognition of the hemodynamics involved is necessary to manage gastroesophageal varices in patients with portal hypertension. Especially, in the management of cases of bleeding from gastroesophageal varices or the prevention of bleeding from gastroesophageal varices, we must choose one of the methods of treatments available such as endoscopic techniques (EIS, EVL, ete.) or interventional therapies (TIPS, BRTO, ete.) according to the variceal structures and hemodynamics. The recognition of the hemodynamics involved is helpful to choose the one of these therapeutic methods which we expect to be efficacious. It is easy for examiners to recognize and reconstruct an image in the mind as a three-dimensional image, but the examiners must also recognize and reconstruct the hemodynamics of gastroesophageal varices to accurately diagnose their structure. The 3D-CD-EUS is helpful to give an objective understanding of the structure of varices. The three-dimensional expression or three-dimension-like expression of gastroesophageal varices is not yet able to express completely the whole structure of gastroesophageal varices, and it is still necessary to further develop the technology in 3D-CD-EUS.