食道領域のendocytoscopyの最新知見

Endocytoscopic Observation of the Esophagus：Detailed Methodology and Novel Findings

要旨●ECSは細胞レベルまで拡大可能な超拡大内視鏡であり，2018年に上市された．扁平上皮の診断において3段階のType分類を提案し，効率的に癌を診断することが可能になった．核密度の上昇と核異型，核の腫大が確認されれば扁平上皮癌で（Type 3），生検診断省略可能である．扁平上皮癌のほかさまざまな食道炎（放射線性食道炎，胃食道逆流症など），Barrett粘膜（腸型粘膜の杯細胞，扁平上皮島），Barrett癌で病理組織を反映する特徴的な画像が得られた．食道に対するECS診断はoptical biopsyを実現し，生検診断省略を可能にする．

　The endocytoscopy system（ECS）is an ultra-high magnification endoscope that allows cell observation in real time in vivo. The latest prototype ECS, GIF-Y0074, is now available on the market. Here, we propose a classification system for the diagnosis of squamous epithelium. This classification is divided into three categories that efficiently differentiate esophageal cancer. An increase in nuclear density and abnormality as well as an enlarged nucleus are distinct features of squamous cell carcinoma（Type 3）. In cases exhibiting these features, biopsy histology can be omitted by referring to the ECS findings. Furthermore, in the case of various types of esophagitis（esophagitis after irradiation, gastroesophageal reflux disease, etc.）, Barrett's epithelium（goblet cells in the intestinal mucosa and squamous islands）, and esophageal cancer, characteristic images that reflect the histological features are obtainable. ECS diagnosis for the esophagus realizes the concept of optical biopsy and enables the omission of biopsy histology.