潰瘍性大腸炎・Crohn病の副病変

Additional Lesions of Ulcerative Colitis and Crohn's Disease

要旨●バルーン内視鏡や拡大観察，NBI（narrow band imaging）などの画像強調観察の普及により，新しい所見が観察されるようになってきた．潰瘍性大腸炎では，粘膜評価に超拡大内視鏡の意義が報告され，さらにNBIを用いた超拡大観察所見も組織所見とよく相関している．また，全大腸炎型において回盲弁から連続的に回腸に炎症が及ぶbackwash ileitisを提示した．Crohn病では，広範囲に認める不整形─類円形潰瘍またはアフタなどの副所見があり，軽微なものもNBIにより容易に視認される．その他，縦列傾向のあるびらんや潰瘍，竹の節状外観，縦走潰瘍瘢痕化に伴う偽憩室，バルーン内視鏡下バルーン拡張術が可能な膜様狭窄，潰瘍出血，狭窄に伴う真性腸石，瘻孔等の副病変を提示する．

　The widespread use of BAE（balloon-assisted endoscopy）and image-enhanced endoscopy, such as magnified colonoscopy and NBI（narrow band imaging）, enables observing new findings in inflammatory bowel disease.

　In UC（ulcerative colitis）, EC（endocytoscopy）is useful for assessing mucosal healing. Findings using EC with NBI also correlate to the histological findings. A case of backwash ileitis that spreads from the ileocecal valve to the ileum in pancolitis-type UC is presented.

　There are some additional findings, such as, irregular ulcer, oval ulcer, or aphtha associated with Crohn's disease. NBI is useful for detecting mild lesions. Erosions or ulcers with longitudinal tendency, bamboo joint-like appearance, pseudo-diverticula with longitudinal ulcer scarring, membranous stenosis treated using balloon dilation by BAE, ulcer bleeding, intestinal bezoar formed by stenosis, and fistula are also presented.