臨牀消化器内科 Vol.27 No.6(4-1)


特集名 患者に優しい内視鏡―経鼻内視鏡とカプセル内視鏡
題名 経鼻内視鏡と経口内視鏡―スクリーニング精度をめぐって (1) 経口内視鏡と経鼻内視鏡には差があるという立場から
発刊年月 2012年 06月
著者 中田 博也 なかた消化器・内科クリニック
著者 榎本 祥太郎 和歌山県立医科大学第二内科
著者 井口 幹崇 和歌山県立医科大学第二内科
著者 玉井 秀幸 和歌山県立医科大学第二内科
著者 加藤 順 和歌山県立医科大学第二内科
著者 一瀬 雅夫 和歌山県立医科大学第二内科
【 要旨 】 経鼻内視鏡は苦痛が少なく,かつ安全性も高いゆえにスクリーニングの内視鏡検査には最適である.しかし,使用する内視鏡が極細径ゆえに,画質が劣り注意が必要である.同時期の経鼻・経口内視鏡を比較すると,情報量は経口内視鏡のほうが2〜3倍多い.胃腫瘍の発見率は経鼻群21/1,280例(1.64%),経口群で32/1,707例(1.87%)で両群間には有意差を認めなかった.胃粘膜萎縮のない群では,経鼻群0.13%に対して経口群は0.79%と有意に高く,胃炎の進展形式別では,胃粘膜萎縮のない群(B群)で経鼻群0.53%に対して経口群3.11%と有意に高かった.経鼻内視鏡の胃癌の発見率は経口内視鏡に劣ることはないが,B群では診断能が劣り,注意が必要である.
Theme More Comfortable Endoscopy -- Transnasal Endoscopy and Capsule Endoscopy
Title Transnasal and Transoral Endoscopies
Author Hiroya Nakata Nakata Medical Clinic
Author Shotaro Enomoto 2nd Department of Internal Medicine, Wakayama Medical University
Author Mikitaka Iguchi 2nd Department of Internal Medicine, Wakayama Medical University
Author Hideyuki Tamai 2nd Department of Internal Medicine, Wakayama Medical University
Author Jun Kato 2nd Department of Internal Medicine, Wakayama Medical University
Author Masao Ichinose 2nd Department of Internal Medicine, Wakayama Medical University
[ Summary ] Transnasal esophagogastroduodenoscopy (EGD) is considered suitable for screening examinations because it is safer and easier to employ than transoral EGD. However, there are many problems with transnasal EGD, including image resolution and poor lighting due to the small caliber of the instruments used. We compared the screening performance of transnasal to transoral EGD. The transnasal EGD group included 1,280 subjects and the detection rate for gastric mucosal neoplasias was 1.64 % (21/1,280). The transoral EGD group included 1,707 subjects and the detection rate was 1.87 % (32/1,707), indicating no significant difference between the two groups. However, the detection rate for transoral EGD (0.79 %) was significantly higher in the screening group of subjects without gastric atrophy than that for the transnasal EGD group (0.13 %). The transoral EGD was better in terms of detecting neoplasias in subjects with H. pylori-related non-atrophic gastritis. The detection rate in the standard EGD group (3.11 %) was significantly higher than that in the transnasal EGD group (0.53 %). These results indicate that the diagnostic performance of transnasal endoscopes is suboptimal for cancer screening, especially in groups of subjects with H. pylori-related non-atrophic gastritis.
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