ダブルバルーン小腸内視鏡検査の有用性―小腸二重造影法との比較

A Comparison of Diagnostic Value Between Double-contrast Study of the Small Intestine and Double-balloon Enteroscopy

要旨　ゾンデ法小腸X線検査とダブルバルーン小腸内視鏡検査（DBE）を施行した38例のX線・内視鏡所見を比較した．非限局性小腸疾患（炎症性・びまん性小腸疾患，消化管ポリポーシス）30例中1例ではDBEが十二指腸までしか挿入できなかった．他の29例ではX線の異常皺襞像（皺襞腫大，皺襞消失）10病変の50％，粘膜所見（潰瘍，多発結節，多発顆粒）13病変の92％，変形7病変の100％がDBEで異常所見として観察された．また，29例中9例（31％）でX線正常部にDBEで微細所見が認められた．限局性小腸病変（小腸腫瘍，小腸・小腸吻合部）8例のうち，DBE挿入不能例，X線非描出例，X線・内視鏡非描出例が各1例存在した．他の5例ではDBEで皺襞集中所見が，X線で狭窄部の性状や小腸索との関係が明瞭であった．以上より，DBEは小腸疾患の診断に有用であるが，特に非限局性小腸病変ではX線検査との併用が必要と考えられた．

　We made a comparative investigation of double-contrast radiographic findings and enteroscopic findings obtained by double-balloon enteroscopy (DBE) in 38 patients with small intestinal pathology. Among 30 patients with inflammatory or miscellaneous small intestinal diseases and polyposis, DBE identified small intestinal lesions in 50％ of swollen or flattened folds, in 92％ of mucosal lesions, and in 100％ of cases of stenosis. DBE also identified diminutive lesions in radiographically uninvolved areas of 9 (31％) out of 29 patients. In 8 patients with localized small intestinal pathology, either one or both procedures failed to identify the lesion in three of the patients. In the remaining 5 patients, DBE was superior to radiography for the determination of mucosal defects whereas radiography provided more information with respect to stenosis and exophytic findings. These observations suggest that DBE is an accurate procedure for the diagnosis of small intestinal pathology, although small intestinal radiography remains as a complementary procedure to DBE.

　1) Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan