小腸疾患の内視鏡診断

Fiberscopic Diagnosis of Small Intestinal Diseases

　1969年に完成された十二指腸ファイバースコープ¹⁾は，それまで食道と胃に限られていた上部消化管の内視鏡領域を，ついに小腸にまで到達させた点で画期的なものであった．長い間内視鏡の進入を退けていた小腸に対するその後の十二指腸ファイバースコープの普及は目ざましく，単に十二指腸の観察だけに止まらず，逆行性膵胆管造影や最近では内視鏡的乳頭切開術などにまで応用されるようになった．

　この十二指腸ファイバースコープの実現は必然的にさらに深部の小腸（すなわち空腸及び回腸）への内視鏡開発を促すきっかけとなり，1970年には早くも十二指腸ファイバースコープによる空腸観察が行われている²⁾が，これに続いて1971年頃から小腸専用内視鏡の開発が試みられるようになった．

　Completion of duodenofiberscope has accelerated the development of more far-reaching fiberscope for the jejunum and ileum, segments of the intestine hitherto least accessible for endoscopy. Since 1971 several intestinal fiberscopes have been exploited. At present there are three kinds made on an experimental basis. They are (1) a fiberscope used in ‘rope-way method’; (2) fiberscope for Sonde method; and (3) jejunofiberscope.

　The first aims at observation and biopsy of the whole intestinal tract by means of intestinal string swallowed beforehand which is attached to the forceps channel of the fiberscope. This method has a drawback as the intestinal loop would shorten like an accordion.

　The second is to have the patient swallow a fiberscope as small and pliable as the duodenoscope as far as possible into the most distal part of the intestine. This procedure also lacks precision because the fiberscope thus made is devoid of not only the biopsy mechanism but the angle device as well. Further, it is not always possible to observe the whole circumference of the intestinal lumen.

　The third method is as it were extended doudenoscopy. This fiberscope is also used perorally, equipped with observation and biopsy device the same as other endoscopes of the digestive tract. However. even the most up-to-date type can reach no futher than 30～50 cm beyond the duodenojejunal angle.

　Inperfect as the present three kinds of fiberscope are, we have described here that there are case reports and investigations on the increase using these fiberscopes. Illustrative cases are also reported to show that one of the most effective methods of study in small intestinal fiberscopy possibly lies in the elucidation of pathological behavior of the small intestine by means of comparing the minute findings of small intestinal fiberscopy and biopsy specimens.