1)拡張術（バルーンブジー，硬性ブジー） (1)上部消化管

Bougie Techniques for Upper Gastrointestinal Stenosis

要旨　上部消化管狭窄を拡張する目的は主に摂食可能とすることであり，拡張器具はTTS型CREバルーンが普及している．急激な過度の拡張は穿孔を誘発するので注意を要する．逆流性食道炎では炎症を改善させたうえで，段階的に拡張する．食道空腸吻合は大半が膜様狭窄で，1回で十分な拡張が得られることが多い．食道癌術後吻合部狭窄は縫合不全が起因していることが多く，難渋する場合がある．胸壁前吻合は屈曲が強く，硬性ブジーも有用であり，状況に応じて使い分ける必要がある．EMR後の狭窄は拡張時期が遅れると瘢痕狭窄が高度になるので，早期から計画的に行う．アカラシアは進行性疾患であり，軽症例に対してバルーン拡張を行う．

　The purpose of dilation to deal with strictures of the upper digestive tract is mainly to make oral intake possible. A PET balloon dilator is popularly used. Hasty and excess dilation induces perforation, but it is also necessary to use other devices properly. In case of reflux esophagitis, after medication for reflux, step dilations are performed. Membranous stricture is mostly seen in cases of esophago-jejunostomy, and sufficient dilation is able to be performed with a single dilation. In case of postoperative esophageal anastomotic stricture, sometimes it is difficult to dilate due to minor leakage. Ante-thoracic anastomosis causes strong bending and a Celestin dilator is also useful. After EMR, delay in starting dilation causes a hard scarred stricture. It is necessary to dilate periodically from as early a time as possible. Achalasia is a progressive disease, so balloon dilation is performed for even mild cases.