バルーン内視鏡：ダブルバルーン内視鏡を中心に—腫瘍性疾患と炎症性疾患に対する診断法の有用性と限界

Utility and Limitations of Balloon-assisted Endoscopy with a Focus on Double-balloon Endoscopy as Diagnostic Method for Neoplastic and Inflammatory Diseases

要旨●腫瘍性疾患と炎症性疾患は，小腸疾患で最も重要でかつ診断治療が難しい病態である．ダブルバルーン内視鏡は詳細な内視鏡観察，ガストログラフィン造影，内視鏡治療が可能であり，それらの病態への診療に大いに貢献できる．腫瘍性疾患に対する有用性は生検によって病理学的診断が得られることであるが，同時にその限界として特に粘膜下腫瘍の生検病理診断を得ることが難しいという問題がある．GISTと異所性膵は肉眼形態が類似するものの治療方針が異なるため治療前に確定診断を得ておきたいが，ともに生検病理診断は困難である場合がある．ダブルバルーン内視鏡は炎症性疾患の内視鏡像を容易に提示できるが，一方で生検病理診断において確定診断が難しい．その他の臨床情報と合わせて診断に到達する．

　Neoplastic and inflammatory diseases are significance in the context of the small intestine and pose challenges for diagnosis and treatment. Double-balloon endoscopy allows meticulous observation and the implementation of gastrografin enterography and endoscopic intervention, thereby helping in the management of these conditions. The utility of a double-balloon endoscope lies in its capacity to procure pathological diagnosis via biopsy in neoplastic disorders. Nevertheless, it has certain limitations, particularly those related to biopsy-based diagnosis of submucosal tumors. Nonetheless, reaching a definitive diagnosis prior to treatment often proves arduous. Although double-balloon endoscopy can readily offer an endoscopic representation of inflammatory diseases, reaching a definitive diagnosis based on biopsy alone is often a formidable task. Therefore, the diagnosis is usually made in conjunction with other pertinent clinical information.