| 特集名 | GERDの臨床 -- 最近の進歩 | |
|---|---|---|
| 題名 | GERDの内視鏡診断の進歩 | |
| 発刊年月 | 2009年 05月 | |
| 著者 | 幕内 博康 | 東海大学医学部消化器外科 |
| 著者 | 島田 英雄 | 東海大学医学部消化器外科 |
| 著者 | 千野 修 | 東海大学医学部消化器外科 |
| 著者 | 西 隆之 | 東海大学医学部消化器外科 |
| 著者 | 山本 壮一郎 | 東海大学医学部消化器外科 |
| 著者 | 名久井 優 | 東海大学医学部消化器外科 |
| 【 要旨 】 | 内視鏡器機の進歩には著しいものがありHi-vision電子内視鏡，拡大内視鏡，NBIはGERDや逆流性食道炎の診断に欠くことのできないものとなっている．ヨード染色にも捨て難いものがある．逆流性食道炎の内視鏡分類にはロサンゼルス分類が用いられている．NERDの内視鏡診断には，NBI拡大やヨード染色が有用である．逆流性食道炎の内視鏡所見と自覚症状の間に乖離のある症例もある．食道胃接合部付近のびらん・潰瘍の良悪性の鑑別は生検でも難しいものがあり，再生上皮の有無，PPI投与後の再検査が望まれる．Barrett食道癌の診断には粘膜パターンをみるためにクリスタルヴァイオレット，酢酸インジゴカルミンを用い，毛細血管パターンにはNBIを併用する拡大内視鏡が有用である． | |
| Theme | GERD -- Recent Clinical Advances | |
|---|---|---|
| Title | Recent Progress in Endoscopic Diagnosis of GERD | |
| Author | Hiroyasu Makuuchi | Department of Digestive Surgery, Tokai University School of Medicine |
| Author | Hideo Shimada | Department of Digestive Surgery, Tokai University School of Medicine |
| Author | Osamu Chino | Department of Digestive Surgery, Tokai University School of Medicine |
| Author | Takayuki Nishi | Department of Digestive Surgery, Tokai University School of Medicine |
| Author | Souichirou Yamamoto | Department of Digestive Surgery, Tokai University School of Medicine |
| Author | Yu Nakui | Department of Digestive Surgery, Tokai University School of Medicine |
| [ Summary ] | Recently, the endoscope and related endoscopic instruments have been dramatically improved. High resolution electronic endoscope, magnifying endoscopes, NBI and chromoendoscopy are indispensable for the diagnosis of GERD. The Los Angeles classification is used for endoscopic classification of reflux esophagitis. Magnifying endoscopy with NBI and iodine staining are useful for endoscopic diagnosis of NERD. There are some case where there is a difference between endoscopic views and subjective systems for determining reflux esophagitis. Differential diagnosis of malignant or benign lesions in erosive or ulcerative lesions in the gastro-esophageal junction is extremely difficult, even if a biopsy examination is performed. The presence of a regenerate epithelium is considered to be evidence of a benign lesion. Reexamination of endoscopic information is often requested after PPI administration. To produce a diagnosis of Barrett's cancer, we use chromoendoscopy with crystal violet or acetic acid indigocarmine staining. Magnifying endoscopy with NBI is also employed to determin emucosal and capillary patterns. |
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