好酸球性食道炎に対して腹腔鏡下噴門側胃切除術，下部食道切除術が奏効した1例

A case of successful laparoscopic lower esophageal resection and proximal gastrectomy for eosinophilic esophagitis

◆要旨：好酸球性食道炎（以下，EoE）は食道上皮への好酸球浸潤を特徴とする食道運動障害や器質的狭窄を引き起こす疾患である．今回，内科的治療に難渋したEoEに対して手術加療を行った1例を経験したため報告する．症例は67歳，男性．2021年4月に脱水・嘔吐を主訴に前医を受診した．上部消化管内視鏡検査で下部食道に縦走潰瘍および白斑を認めた．生検の結果，60個/HPFの好酸球浸潤を認め，EoEの診断となった．薬物治療を含む各種内科的治療に抵抗性であったため当院紹介となり，腹腔鏡下下部食道・噴門側胃切除を施行した．術後，食事摂取良好であった．内科的治療が奏効しない場合，外科的治療が有効である可能性がある．

　Eosinophilic esophagitis（EoE）is a disease characterized by multiple eosinophils infiltrating the esophageal epithelium, resulting in esophageal motility disorder and fixed stricture. Here, we report a case of EoE that was refractory to medical treatment and treated by surgery.

The patient, a 67-year-old man, presented to his previous doctor in April 2021 with complaints of dehydration and vomiting. Upper gastrointestinal endoscopy revealed a circumferential white coat-covered ulcer in the lower esophagus. Biopsy revealed 60 eosinophils/HPF, leading to the diagnosis of EoE. The patient was referred to our department because of resistance to various medical treatments including medication. The patient underwent laparoscopic lower esophageal resection and proximal gastrectomy. Postoperatively, the patient`s oral intake improved. Surgical treatment may be effective when medical treatment is unsuccessful.