NBIおよびBLIを使いこなす—十二指腸

Magnifying Endoscopy with Narrow Band Imaging and Blue Laser Imaging for the Diagnosis of Superficial Non-ampullary Duodenal Epithelial Tumors

要旨●表在性非乳頭部十二指腸上皮性腫瘍（SNADETs）に対するNBI，BLI併用拡大内視鏡診断について概説した．SNADETsの拡大内視鏡診断は，胃癌の診断と同様にDLの同定，および微小血管構築像と表面微細構造を詳細に観察することが基本となる．加えて，SNADETsでは粘液形質を推定しながら内視鏡診断を進めることが重要であり，中でも腸型の粘液形質を有する病変ではWOSによって微小血管が視認できない場合が多く，表面微細構造に注目した観察が必要となる．今後，本邦からの統一した拡大内視鏡診断基準の作成が期待される．

　We reviewed the diagnosis of SNADETs（superficial non-ampullary duodenal epithelial tumors）using ME（magnifying endoscopy）with narrow band imaging or blue laser imaging. As well as in other gastrointestinal tract, the identification of demarcation lines and detailed observation of microvascular and microsurface patterns improve the diagnosis in SNADETs. It is important to estimate the mucin phenotypes while performing endoscopic SNADETs diagnosis. Microvascular patterns are often not visible due to white opaque substance in lesions with intestinal-type mucin phenotype. We consider that the observation focusing on microsurface patterns rather than microvascular patterns may be the key to the ME diagnosis of SNADETs.