| 特集名 | 小腸内視鏡のupdate | |
|---|---|---|
| 題名 | 小腸内視鏡の基本 | |
| 発刊年月 | 2007年 03月 | |
| 著者 | 小林 剛 | 日本医科大学消化器内科 |
| 著者 | 田中 周 | 日本医科大学消化器内科 |
| 著者 | 山田 祐希江 | 日本医科大学消化器内科 |
| 著者 | 江原 彰仁 | 日本医科大学消化器内科 |
| 著者 | 三井 啓吾 | 日本医科大学消化器内科 |
| 著者 | 瀬尾 継彦 | 日本医科大学消化器内科 |
| 著者 | 藤森 俊二 | 日本医科大学消化器内科 |
| 著者 | 坂本 長逸 | 日本医科大学消化器内科 |
| 【 要旨 】 | カプセル内視鏡 (VCE) とダブルバルーン内視鏡 (DBE) の開発により，小腸疾患の診断，治療は目覚ましい進歩を遂げた．本稿では両検査法の適応疾患，禁忌，偶発症，前処置や鎮静法について概説する．いずれも原因不明の消化管出血がもっとも多い適応となっている．滞留がVCEの唯一の偶発症であり，狭窄，瘻孔例は禁忌となっているため，DBEのみに適応がある．とくにDBEは組織学的検査のほか，止血処置，狭窄部位の拡張，異物回収などのさまざまな内視鏡治療も可能であるため，DBEが施行可能な環境であれば，今後狭窄症例に対してもVCEの適応が広がる可能性があると思われる．一方DBEの偶発症として，従来の内視鏡に伴うものに加え，急性膵炎の発症が少数報告されている．短時間で愛護的に行えば，比較的安全な検査法と思われる．今後両者のさらなる普及のためには，安全性を含めた明確なガイドラインの作成が望まれる． | |
| Theme | Update of Endoscopy for Small Intestine | |
|---|---|---|
| Title | Video Capsule Endoscopy and Double Balloon Endoscopy | |
| Author | Tsuyoshi Kobayashi | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Shu Tanaka | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Yukie Yamada | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Akihito Ehara | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Keigo Mitsui | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Tsuguhiko Seo | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Shunji Fujimori | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| Author | Choitsu Sakamoto | The Department of Internal Medicine, the Division of Gastroenterology, Nippon Medical School |
| [ Summary ] | Video capsule endoscopy (VCE) and double balloon endoscopy (DBE) have had a dramatic impact on the diagnosis and treatment of small intestinal diseases. In this section, we evaluate the indications, contraindications, complications, and necessary preparation or sedation pertaining to each modality. The presence of occult bleeding is currently the most reliable indicator for the use of either type of examination. However, only DBE is indicated in patients with small bowel strictures and fistulae for fear of entrapment of the VCE in such cases, due to intestinal stenosis. In particular, DBE enables tissue sampling, dilatation of small bowel stenosis and removal of foreign bodies while allowing for therapeutic intervention in patients with small intestinal hemorrhages. Therefore, in patients with suspected alimentary tract stenosis, VCE should only be undertaken in centers with fully equipped endoscopic facilities, that would allow for intervention should the capsule endoscope become entrapped. As for complications involving DBE, a few cases of acute pancreatitis have been reported in addition to traditional enteroscopic complications. Careful insertion of the enteroscope should eliminate such complications. There is an accumulating body of evidence evaluating VCE and DBE in the treatment of small bowel diseases, and guidelines for both examinations are beginning to emerge. |
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