Barrett食道癌の境界を読む―範囲診断を中心に

Endoscopic Diagnosis of Superficial Barrett's Esophageal Cancer with the Magnified Endoscopy

要旨　自験8例11病変のBarrett食道表在癌をもとに通常内視鏡，インジゴカルミンによる色素内視鏡，拡大内視鏡による側方伸展範囲診断成績を検討した．通常内視鏡での側方伸展境界正診率は45％と低く，インジゴカルミン撒布を併用しても正診率は向上しなかった．11病変中5病変に0-IIb伸展を伴っており，この0-IIb部の診断が困難であったためと考えられた．一方，拡大内視鏡を施行した7病変中5病変（71％）では側方伸展範囲を正診しえた．拡大内視鏡では腫瘍部に特有の異常血管が認められ，異常血管分布の境界として側方伸展境界を診断しえた．拡大内視鏡にて誤診した原因として癌が非腫瘍性粘膜で被われ中間層を側方伸展した発育様式が考えられた．しかし中間層置換範囲は最大2mmと短く，拡大内視鏡はBarrett食道表在癌診断に有用と思われた．

　The accuracy of the marginal diagnosis of superficial Barrett's esophageal cancer was only 45％ with conventional endoscopy. However, that was improved to 71％ with magnified endoscopy. The surface micro-vessels were able to be observed by magnified endoscopy and the micro-vessels of superficial Barrett's cancer revealed an irregular pattern. Because of this, the lateral margin was able to be diagnosed by magnified endoscopy.

　In case 2, the cancer growth was under non-neoplastic epithelium, so the surface vascular and pit pattern was normal. The diagnosis of the lateral margin with magnified endoscopy was impossible in this case, but the distance of lateral growth under the non-neoplastic epithelium was only 2mm. Those observations show that magnified endoscopy was useful for the diagnosis of superficial Barrett's esophageal cancer.

　1) Department of Gastroenterlogy, Saku Central Hospital, Nagano, Japan