食道粘膜の拡大観察―Barrett食道癌の早期診断

Magnifying Endoscopy for Early Detection of Barrett's Esophageal Carcinoma

要旨　Barrett食道を発生母地とする食道腺癌の増加が大きな問題とされ，内視鏡検査や生検によるサーベイランス法が提唱されている．今回，拡大内視鏡を用いた検査による早期Barrett食道癌発見の可能性について述べた．拡大観察が可能なスコープを使用し，まず通常観察を詳細に行い，目的に応じた色素撒布を施行して色素内視鏡検査を行う．異常所見を認めた際には，その部位に目標を絞っての拡大観察を行い小窩模様の評価を行い，最終診断に関しては同部よりの生検に委ねるのが妥当であると考えている．いまだ，早期Barrett食道癌の拡大観察例は少ない．今後，症例の蓄積により病理組織所見を反映する拡大内視鏡所見の分類が必要である．

　Cases of adenocarcinoma of the esophagus developing from Barrett's esophagus are increasing, and endoscopic screening and surveillance using biopsies are emphasized for its early detection. The possibility of early detection of Barrett's esophageal carcinoma by magnifying endoscopy is shown. Our surveillance method begins with conventional observation in detail by the endoscope allowing magnification, followed by chromoendoscopy with staining according to its purpose. When an abnormal finding is recognized, magnifying endoscopy is carried out on the verified lesion to examine its pit pattern, and the final diagnosis is made by the pathological examination of the biopsy specimen from the lesion.

　Magnifying endoscopy is not yet used customarily to observe early Barrett's esophageal carcinoma. Controlled investigations using magnifying observation are required with large numbers of patients detecting pattern types suggesting pathology.