出血を来す小腸腫瘍性病変の診断と治療─上皮性腫瘍

The Diagnosis and Treatment for the Small Bowel Epithelial Tumors with Bleeding

要旨●消化管出血では，顕出血を伴わないときも常に小腸上皮性腫瘍を疑う必要がある．特に小腸癌は臨床症状を契機に精査されるとき，病変の検出は容易であり，速やかに診断し適切な治療へ導く．腹部−骨盤部X線造影CT検査で所見がないとき，カプセル内視鏡による精査は有用である．今日，小腸癌に対する補助化学療法の有用性を検証する動きが加速している．検査方法は進歩しているが，診断契機は臨床症状の出現であることは以前と変わりがない．そのため，診断時には既に進行していることが多く，早期診断が課題である．また，本邦の罹患率や予後などの疫学データの集積も，診断や治療の進歩を検証するために必要であり，今後の課題である．

　In case of gastrointestinal bleeding, small bowel epithelial tumors should be suspected even if the patient does not have any symptoms of overt bleeding. When small bowel adenocarcinoma is suspected based on the presence of clinical symptoms, tumor can be detected easily. Hence, early diagnosis should be made, thereby providing optimal treatment. If the findings of the abdominal and pelvic computed tomography with contrast enhancement are negative, small bowel capsule endoscopy is useful for further diagnosis. Recently, the movement to validate the efficacy of adjuvant chemotherapy for small bowel adenocarcinoma is accelerating.

　Despite improvement in the diagnostic methods, the trigger for the diagnosis of small bowel adenocarcinoma depends on the initiation of symptoms, as was the case prior to the abovementioned improvement. This means that small bowel adenocarcinoma is often diagnosed at an advanced stage even today. Our task is to establish a method for the early diagnosis of small bowel adenocarcinoma. Furthermore, we need to create a database for epidemiologic data such as the incidence and prognosis of this condition for comparing the benefits of diagnostic and therapeutic innovations.