対策型胃内視鏡検診における観察撮影法─経鼻内視鏡

Technical Tips for an Observational Procedure for Stomach Mass Examination in a Regional Community-based Screening:Transnasal Endoscopy

要旨●本稿では対策型胃内視鏡検診における経鼻内視鏡での前処置を含めた観察方法とポイントについて概説した．経鼻内視鏡での鼻腔の決定・ルートと前処置では，偶発症のリスクを下げ受診者の負担を減らすよう，愛護的な操作を常に意識する．経鼻内視鏡を含め内視鏡検査の目的は，病変を見落とさないように適正な空気量で胃全体を網羅することが大切である．撮影枚数は，少ないと網羅性に欠け，多すぎてもダブルチェックに手間取るため，30〜40枚が適当である．特に観察・撮影時のポイントでは空気量を調整し，動的観察や観察しづらい部位を認識しながら検査を行うことが重要である．

　Recently, transnasal endoscopy has met the growing demand for stomach mass examination in regional community-based screening. In this article, pretreatment procedures and technical tips for transnasal endoscopy are outlined. When choosing the route and pretreatment of nasal endoscopy, a physician should always take into account the careful operation of a flexible tube to reduce the risk of an accident and decrease the pain that a patient may feel during the procedure. Endoscopic examination, including transnasal endoscopy, should employ an appropriate volume of air and visualize the entire range of the stomach to avoid overlooking any lesion. Also, an adequate number of photographs is required, and between 30 and 40 photographs is suggested per person because it is difficult to review more than 40 photographs and less than 30 photographs may provide an incomplete assessment. It is critical to understand that the outcome of transnasal endoscopy strongly depends on the visualization of areas that are difficult to reach and on the appropriate adjustment of the air volume.