小さな小腸血管性病変

Small Vascular Lesions of the Small Intestine

要旨　小腸血管性病変は小腸出血の原因のうち，かなりの部分を占めている．しかし，その内視鏡所見は様々で，用語や分類も一定していない．消化管の血管性病変は，病理組織学的に静脈の特徴をもつangioectasia，動脈の特徴をもつDieulafoy's lesion，動脈と静脈の特徴をもつarteriovenous malformationの3つに分類できる．これを踏まえ，われわれは小腸血管性病変の内視鏡所見を，拍動の有無に着目して6つのタイプに分類した．この分類を用いることで，各病態に合わせた治療方針を決定できる．また，内視鏡所見のうえでは統一した記載が可能となり，確かな知見を集積する一助となると信じている．

　Although small-intestinal vascular lesions account for the bleeding source in a large percentage of patients with Mid-GI-bleeding, observations by endoscopy vary, and their terms have not been standardized. There are 3 pathological conditions of vascular lesions. Angioectasia is characterized by venous/capillary lesions, Dieulafoy's lesion is characterized by arterial lesions, and Arteriovenous malformation is a condition in which arteries and veins are directly connected without capillary beds. We classified vascular lesions with consideration of the presence or absence of pulsatility. The presence or absence of arterial components provides important information for understanding the pathological conditions. This classification will be useful for selecting hemostatic procedures and outcome studies.