挿入から観察まで─私のコツすべて教えます─極細径スコープ

Tips of Colonoscopic Insertion Technique:A Soft Thin Colonoscope

要旨●大腸内視鏡の挿入において苦痛の発生を避けるためには，挿入時，内視鏡の直線化を保った軸保持短縮法が重要であるが，腸管癒着例，高齢の痩せ型女性に代表される過長，複雑な走行を伴う症例などでは，プッシュ操作を主体とした挿入法を選択せざるをえなく，苦痛の大きい検査となってしまう．プッシュ操作主体の挿入には細く軟らかい内視鏡が適しているが，従来の細径軟性スコープは深部挿入性が悪かった．PCF-PQ260（オリンパス社製）は，受動彎曲と高伝達挿入部の搭載により，プッシュ操作主体で苦痛が少なく深部挿入性が向上した．2005年5月〜2015年12月までにPCF-PQ260を用いて4,029例に対して全大腸内視鏡検査を施行した．NRS（numerical rating scale）を用いた疼痛の平均値は，癒着やS状結腸過長などの挿入困難因子を有する例で2.6±2.5，挿入困難因子のない例で1.05±1.7であり，sedationなしでも十分許容可能な苦痛の度合いと考えている．PCF-PQ260は男性肥満患者においては深部挿入は困難であり，汎用機ではなく，痩せ型の患者，複数回の腹部手術例を有する女性患者に対するbackupスコープとしての位置付けと考える．

　It is important to keep the colonoscope straight to perform a minimally uncomfortable colonoscopy. The tube insertion using push method cannot be avoided in patients with intrapelvic bowel adhesion ; thin, elderly female patients with long colons ; and patients in whom the access to the colon is difficult due to various factors ; in such cases, a colonoscopy will be very uncomfortable. However, a soft, thin colonoscope will be suitable for tube insertion with less discomfort in cases where it has been difficult to get to the cecum using a conventional soft and thin scope. Olympus PCF-PQ260 is equipped with the new technologies passive bending and high force transmission insertion tube, enabling easy tube insertion and access to the cecum with minimal patient discomfort. Between May 2005 and December 2015, 4,029 colonoscopies were performed using PCF-PQ260, without conscious sedation. The average discomfort value was 2.6±2.5 in patients with difficulty factors such as colonic adhesion and long colon and 1.05±1.7 in patients without any difficulty factors, as evaluated by a numerical rating scale. We think this discomfort score is satisfactory. On the contrary, when using PCF-PQ260, it is difficult to perform a comfortable colonoscopy, especially in obese male patients, because the scope is thin and soft. Thus, for thin patients or female patients with suspected bowel adhesion, the PCF-PQ260 should be positioned as a backup scope for the conventional one.