出血性小腸疾患に対する診断手技―バルーン内視鏡を主体に

Diagnostic Technique for Detecting Hemorrhagic Small Intestinal Diseases by Balloon Endoscopy

要旨　出血性小腸疾患に対する診断学体系はカプセル内視鏡とバルーン内視鏡の登場により大きく変わってきた．しかし出血の責任病変同定に関してはいまだ問題点も多い．一般臨床の場では原因不明の出血の場合，小腸出血が疑われるが，その中には通常の検査タイミングでは発見できない大腸や胃のangioectasiaや憩室出血なども含まれる．今後は得られた所見と責任病変の関連を明確にしていくことが臨床における治療方針決定に必須である．そのうえでCEとDBEをより効率的に使い分けた診療体系の確立が望まれる．

　The advent of capsule endoscopy and balloon endoscopy has revolutionalized diagnostic methods for detecting hemorrhagic small intestinal diseases. However, endoscopic diagnosis leaves some questions in identifying the cause of hemorrhage. Generally, bleeding is considered to come from the small intestine when the bleeding cause is not clear. Those symptoms, however, could also be ascribed to bleeding from the colonic diverticulum or gastric and colonic angioectasia.

　Effective treatment needs clarification of the relation between the endoscopic findings and the true cause of hemorrhage. It is essential to determine a diagnostic method based on highly selective use of capsule endoscopy and balloon endoscopy.