| 特集名 | カプセル・バルーン内視鏡の新展開 | |
|---|---|---|
| 題名 | バルーン内視鏡編 (2) 大腸挿入困難，治療困難例への応用 b．治療困難例に対する応用（ダブルバルーン内視鏡） | |
| 発刊年月 | 2013年 12月 | |
| 著者 | 藤本 愛 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 浦岡 俊夫 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 堀井 城一朗 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 後藤 修 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 落合 康利 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 高橋 幸志 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 著者 | 矢作 直久 | 慶應義塾大学医学部腫瘍センター低侵襲療法研究開発部門 |
| 【 要旨 】 | 近年，内視鏡分野の機器開発の進歩により，ESDは広く普及してきている．ESDによる一括切除は正確な病理組織診断が可能となり，それに基づいた適切な治療方針を提示することが可能となった．しかし，大腸ESDでは，その解剖学的特性により内視鏡操作が不安定な状態での治療となると，手技の長時間化や穿孔などの偶発症のリスクが高まる．手技を安全に完遂させるには安定した内視鏡操作が必要であり，内視鏡操作性がきわめて不良の症例では，ダブルバルーン内視鏡を積極的に用いることが勧められる． | |
| Theme | New developments in capsule/balloon-assisted endoscopy | |
|---|---|---|
| Title | Colorectal ESD using double-balloon endoscopy | |
| Author | Ai Fujimoto | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Toshio Uraoka | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Joichiro Horii | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Osamu Goto | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Yasutoshi Ochiai | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Koji Takahashi | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| Author | Naohisa Yahagi | Center for Research and Development of Minimally Invasive Treatment, Cancer Center, Keio University |
| [ Summary ] | Because of improvements in endoscopic devices which have led to reduced learning curves for endoscopists, colorectal ESD (endoscopic submucosal dissection) has become widely implemented in recent years. En-bloc resection using ESD procedures can result in more accurate histological assessment and subsequently make it possible to determine appropriate treatment strategies for additional treatment or follow ups. However, colorectal ESD has some disadvantages such as technical difficulties, longer operation times and higher complication rates compared to gastric ESD because of the poor maneuverability of colonoscopes caused by angulation and looping of the proximal or sigmoid colon. We usually performe colorectal ESD with a short DBE (double-balloon endoscope) system (EI-530B endoscope : Fujifilm Co, Tokyo, Japan) in such technically difficult cases. The total length of the shaft, and working channel of this endoscope are 182 cm, 152 cm, 9.4 mm, and 2.8 mm, respectively. The principle of DBE is that holding the colon wall with a balloon attached to the distal end of a soft overtube results in better maneuverability of colonoscopes. Some advantages of the use of DBE for colorectal ESD in cases of poor maneuverability with conventional colonoscopies are described. | |