1) 上皮性腫瘍（腺腫，癌）

Small Bowel Adenoma and Carcinoma

要旨　小腸腺腫は良性疾患であり基本的に治療不要だが，まれに癌化することもありcapsule endoscopy（CE）によるスクリーニングやdouble balloon endoscopy（DBE）による内視鏡治療が有用である．特に家族性大腸腺腫症では十二指腸で高率に癌化するため注意が必要となる．小腸癌は特異的な症状がなく早期発見は困難であったが，DBEで小腸全域の組織診断が可能となり早期診断が期待される．なおCEは狭窄症状がなくても癌性狭窄による滞留の危険性があるため，適応には慎重でなければならない．従来のX線検査にCEやDBEを安全かつ効率的に組み合わせることで，小腸腫瘍の早期診断や予後の改善に繋がると期待される．今後patencyカプセルの保険認可や小腸癌の化学療法の確立が望まれる．

　Although, in principle, it is not necessary to treat small bowel adenoma, because of its benign characteristics, there is always a possibility of carcinoma arising from adenoma. Therefore, it is useful for patients to be screened by capsule endoscopy (CE) and treated by double balloon endoscopy (DBE). In particular, it is necessary to pay attention to patients with familial adenomatous polyposis because there is a high risk that their duodenal adenoma can change to carcinoma. There are no specific symptoms in patients with small bowel carcinoma, so it is difficult to diagnose it at an early stage by imaging modalities such as radiological enteroclysis and computed tomography, and classical endoscopy. However, DBE makes it possible to diagnose the carcinoma of the entire small bowel at an early stage by taking tissue samples for pathological assessment. Small bowel tumors can be diagnosed at an early stage by combining image modalities, CE and DBE, safely and efficiently, resulting in improving the patient's prognosis. In the near future, we expect that the patency capsule will be approved for use and effective chemotherapy for small bowel carcinoma will be established.