小腸非腫瘍性疾患の内視鏡診断

Endoscopic Diagnosis of Nontumorous Lesions of the Small Intestine

要旨　小腸の非腫瘍性疾患の診断に有用と考えられる内視鏡所見として，潰瘍性病変，狭窄，粘膜像，および血管性病変に着目してダブルバルーン内視鏡（DBE）とカプセル内視鏡（VCE）所見を呈示した．小腸内視鏡検査を用いると，微細な潰瘍性病変が観察可能であるが，縦走潰瘍，輪状潰瘍，およびその他の潰瘍に大別して鑑別診断を論じるのが妥当と思われる．狭窄はCrohn病，非特異性多発性小腸潰瘍症，非ステロイド性消炎鎮痛薬起因性小腸潰瘍，虚血性小腸炎でみられる所見であるが，随伴病変を評価することで鑑別は比較的容易である．粘膜像の異常として，皺襞腫大，結節状粘膜，絨毛腫大・萎縮，白点が挙げられるが，これらのみで診断を確定することは容易ではない．一方，小腸の血管性病変の診断は小腸内視鏡検査で飛躍的に向上した．今後，小腸疾患の診断におけるX線と内視鏡検査の役割，およびVCEとDBEの使い分けを確立する必要がある．

　For accurate enteroscopic diagnosis, we classified findings obtained by double balloon endoscopy (DBE) and video-capsule endoscopy (VCE) into ulcers, stenosis, mucosal pattern and vascular lesions. Although DBE and VCE can depict diminutive ulcerous lesions, a subclassification of the small intestinal ulcers into linear, circular and other configurations seems to be appropriate for clinical diagnosis. Even though severe stenoses occur in Crohn's disease, in the case of nonspecific multiple ulcers of the small intestine, nonsteroidal-anti-inflammatory drug-induced ulcers and ischemic enteritis, an assessment of accompanying lesions can lead to a correct diagnosis. Thickened mucosal folds, nodularity, villous swelling and atrophy, and white spots are representative mucosal patterns found in the diseased small intestine. However, a correct diagnosis can not be made by the mucosal findings alone. In contrast, the diagnosis of vascular lesions has been improved dramatically by means of DBE and VCE. Such an improvement in the accuracy of enteroscopy suggests a need for gastroenterologists to establish an algorithm of diagnostic procedures for patients suspected of having small intestinal pathology.