日本食道学会拡大内視鏡分類（JES-BE分類）の有用性

The Efficacy of The Japan Esophageal Society Barrett's Esophagus Magnification Endoscopy（JES-BE）Classification System for Superficial Barrett's Esophagus-related Neoplasms

要旨●Barrett食道に対する日本食道学会拡大内視鏡分類（JES-BE分類）の有用性を検討した．背景粘膜はSSBE 5病変，LSBE 4病変で内視鏡像と病理組織像との正確な対比が可能であった平坦部分での関心領域49か所で評価した．簡素化JES-BE分類フローチャートに従い，関心領域における内視鏡診断の診断精度を検討したところ，全体の感度89.2%，特異度100%，正診率91.8%と良好な結果であった．MP（mucosal pattern）とVP（vascular pattern）別ではMPの感度・正診率がVPと比べ約20%高く，表面構造が微小血管構造より診断精度が高く，MPがより重要な所見であると考えられた．また，本分類ではSSBE由来の癌に比べLSBE由来の癌の診断精度は低い傾向にあり，誤診例はMPおよびVPにおけるirregular/regular判定に苦慮した2か所とflat patternの2か所であった．LSBE内にこのような所見を認める場合には，診断精度が最も高い酢酸併用NBI拡大観察が有用となる可能性がある．

　We assessed whether the JES-BE（the Japan Esophageal Society Barrett's Esophagus magnification endoscopy）classification for superficial BAC（Barrett's carcinoma）was available in our facility in our institution. For 49 target lesions with BAC or non-neoplasm, the diagnostic accuracy of the JES-BE classification was estimated. The endoscopic diagnosis was based on a condensed JES-BE diagnostic flowchart consisting of MP（mucosal pattern）irregularity or VP（vascular pattern）irregularity. For all target lesions, the sensitivity, specificity, and overall accuracy were 89.2%, 100%, and 91.8%, respectively. It is acceptable and trustworthy to use the JES-BE classification system, which includes a simplified diagnostic flowchart for determining BAC and non-neoplasm. However, it was believed that MP was a more important view because the sensitivity and overall accuracy using MP were higher at 〜20% rates than those using VP. Additionally, according to this JES-BE classification, the diagnosis accuracy of BAC derived from long-segment Barrett's esophagus tended to be lower than that of BACs with short-segment Barrett's esophagus origins. Four lesions, including two flat patterns and two challenging assessments of irregularity in MP and VP, were misdiagnosed in this study. The highest diagnosis accuracy narrow-band imaging magnifying observation with acetic acid spraying may be helpful for such lesions.