| 特集名 | 逆流性食道炎をめぐる新しい流れ | |
|---|---|---|
| 題名 | 食道胃接合部領域における良悪性の鑑別診断 | |
| 発刊年月 | 2004年 11月 | |
| 著者 | 友利 彰寿 | 佐久総合病院胃腸科 |
| 著者 | 小山 恒男 | 佐久総合病院胃腸科 |
| 著者 | 宮田 佳典 | 佐久総合病院胃腸科 |
| 著者 | 堀田 欣一 | 佐久総合病院胃腸科 |
| 著者 | 米湊 健 | 佐久総合病院胃腸科 |
| 著者 | 森田 周子 | 佐久総合病院胃腸科 |
| 著者 | 竹内 学 | 佐久総合病院胃腸科 |
| 著者 | 田中 雅樹 | 佐久総合病院胃腸科 |
| 【 要旨 】 | 逆流性食道炎では，食道胃接合部にびらんやポリープなどの良悪性鑑別を要する病変が生じる．通常内視鏡による病変の形，色調および表面性状などの観察に加え，拡大内視鏡による微細表面構造の観察が鑑別に有用である． 粘液が付着していると粘膜面の観察が困難だが，前処置にプロナーゼを用いてあらかじめ粘液を分解しておくと，内視鏡下洗浄にて容易に粘液が除去され粘膜面を観察しやすくなる．また，接合部は内腔が狭く全体像が見えにくいが，深吸気時には胸腔内圧が下がり接合部が食道側へ移動するため観察が容易になる．それでも視野が不良な場合には，先端透明フードを使用すると良好な視野が得られる．炎症が強い時期には内視鏡的にも組織学的にも正確な診断が困難な場合が多いため，PPIにて炎症が改善した後に再検することが重要である. |
|
| Theme | Recent Advances in Diagnosis and Treatment of Reflux Esophagitis | |
|---|---|---|
| Title | Efficacy of Magnifying Endoscopy for Differential Diagnosis of Esophago-Gastric Junctional Lesions | |
| Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
| Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
| Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
| Author | Kin-ichi Hotta | Department of Gastroenterology, Saku Central Hospital |
| Author | Ken Kominato | Department of Gastroenterology, Saku Central Hospital |
| Author | Shuko Morita | Department of Gastroenterology, Saku Central Hospital |
| Author | Manabu Takeuchi | Department of Gastroenterology, Saku Central Hospital |
| Author | Masaki Tanaka | Department of Gastroenterology, Saku Central Hospital |
| [ Summary ] | The differential diagnosis of lesions located on the esophago-gastric junction (EGJ) is sometimes difficult, because reflux esophagitis may cause inflammation on these lesions. Treatment with proton pump inhibitors (PPI) may improve inflammation, so the endoscopic and histological diagnosis can become easier. Conventional endoscopy gave us important information concerning color, shape and surface pattern of lesions. Magnified endoscopy gave us further information about pit and micro-vascular patterns. Therefore, diagnoses may be precise with magnified endoscopy. Fig. 4a-4e revealed a protuberant lesion on the EGJ. The lateral margin was unclear but the surface was irregular. Differential diagnosis was difficult with conventional endoscopy, but magnified endoscopy revealed a large villous pattern without irregular vessels, so the lesion was diagnosed as benign. The biopsy specimens showed only inflammation. Fig. 5a-5d revealed a small protuberant lesion. The margin was unclear and the surface was smooth. Magnified observation was impossible because the scope was of the conventional type, so the magnified endoscopy was planned two months later. The shape and size was same but the magnified endoscopy revealed irregular pit and micro-vascular patterns. The lesion was diagnosed as adenocarcinoma. Magnified endoscopy was useful for differential diagnoses, like this. Endoscopic submucosal dissection was performed and the pathological diagnosis was intramucosal adenocarcinoma. |
|