食道アカラシアの内視鏡診断

Endoscopic Diagnosis of Achalasia

要旨　食道の愁訴を訴える症例に対して，食道アカラシアの診断を思いつかず，またその内視鏡診断の記載項目を知らない医師が多い．本稿では1984年に刊行された本症の内視鏡診断基準について述べ，その典型例を解説した．本症の問題点としてまず基本的な内視鏡観察の手順を述べた．本症は若年者からの発症が多く，日常の嚥下障害の改善が治療によりどのような効果・内視鏡所見の変化を来すかが問題となる．また病悩期間と発癌の関係を考察した．本症での発癌頻度は4.9％前後であり，以前は術後の逆流性食道炎からのBarrett食道癌が多かったが，最近では扁平上皮癌が術前，術後問わずに粘膜癌の状態で発見される時代になってきた．内視鏡的にこのような粘膜癌を見つけだす方法論について述べた．

　There are few clinicians who think of achalasia and know endoscopic diagnostic criteria of achalasia when examining a patient with esophageal complaints. In this article, we mentioned the endoscopic diagnostic criteria of this disease published in 1984 and illustrated typical cases.

　The onset of the disease is usually seen in juvenile. The changes of the endoscopic findings and symptoms by the treatment are important. The relationship between the length of the disease and the carcinogenesis was discussed. The incidence of the malignant disease arising from achalasia was about 4.9%, although cancer arising from the Barrett's esophagus due to postoperative reflux esophagitis was common in the past, the mucosal squamous cell carcinoma has increased in number regardless of the operation. The endoscopic techniques how to detect these superficial lesions were mentioned.