小腸の小病変の診断機器の進歩とアルゴリズム

Advance of Diagnostic Modalities for the Small Lesion in the Small Bowel and Its Algorithm

要旨　近年臨床導入されたカプセル内視鏡（VCE）とバルーン内視鏡（BE）により，これまで画像診断で捉えることのできなかった小さな病変（1cm以下）が数多く発見されるようになってきた．当科で診断された551例411病変を対象とし，小病変の検討を行った．小病変は粘膜面の1cm以下の範囲で異常を来す疾患と定義した．小腸疾患の内訳のなかでは炎症性疾患が小病変を最も多く有し，保有率は69/411病変で全体の16.8％，疾患群内の44％であった．小病変のみの頻度では血管性病変が最も高かった．小病変診断のアルゴリズムは現状ではVCEを先行し，診断がつかなければ再度VCEを行うか，治療も兼ねたBEを検討することと思われる．

　In recent years it has become possible to discover a small lesion less than 1cm, which would not have been easily detected by imaging until now with the clinical introduction of capsule endoscopy and balloon endoscopy. We reviewed 551 small lesions in 411 cases diagnosed in our department. Small lesions were defined as those lesions in a range equal to/or less than 1cm of the mucosal surface. Inflammatory disease had most small lesions in small bowel diseases, and the prevalence was 69/411 cases, 16.8％ of the total lesions, and 44％ of the small lesion category. Most of the small lesions were vascular legions. In the algorithm for the diagnosis of small lesions, the initial examination is capsule endoscopy, and if the finding is not abnormal, capsule endscopy is repeated or balloon endoscopy is chosen combined with intervention to remove the lesion.