INTESTINE Vol.18 No.3(5-2)

特集名 今,変わるのか? 大腸微小病変の取り扱い
題名 微小腫瘍発見の工夫 (2) NBI抜去観察における大腸微小腫瘍発見の工夫
発刊年月 2014年 05月
著者 中村 尚志 調布外科・消化器科内科クリニック
著者 傅 光義 中国医科大学付属第一医院消化器内科
【 要旨 】 新型NBI system(EVIS LUCERA ELITE)を使用した全大腸内視鏡検査における存在診断は,従来のシステムと比較しNBIの明るさが向上し観察範囲が広くなったため,通常光観察と同様に腸管腔に十分な送気を行い,視野が確保できれば隆起型病変を認識することは比較的容易となった.一方,表面型病変では,送気を行い腸管腔の視野を確保しても存在診断は困難である.そこで,表面型においては,brownish areaや藤井のいうO-ring signの色調変化を捉えることで病変の拾い上げが可能となり,大腸領域においてもNBI観察の存在診断の時代が到来したと考える.そこで,当クリニックにおけるNBI抜去観察における大腸微小腫瘍発見の工夫について述べる.
Theme Can we change to treat for diminutive colorectal polyp ?
Title How to detect, small colorectal adenomas with Narrow Band Imaging during colonoscopy
Author Hisashi Nakamura Department of Gastroenterology, Chofu Surgical Clinicl
Author Kuang-I Fu Department of Gastroenterology, The First Hospital of Chinese Medical University
[ Summary ] The new Narrow Band Imaging (NBI) system (EVIS LUCERA ELITE) is brighter than the first generation system. Therefore, the system provides better detection of protruded/elevated lesions during colonoscopy with both conventional white light imaging and NBI, even if the colonic lumen is extended by insufflations. On the other hand, superficial colorectal neoplasms are still more difficult to detect in some situations. To detect superficial neoplasms, it is important to keep in mind that these lesions often have special color variations. These lesions may have "brownish areas" or an "O-ring sign" as reported by T. Fujii. These may be observed when withdrawing the colonoscope during NBI. It is possible to detect more superficial neoplasms with these signs in mind when using NBI during colonosocopy. Considering the possibilities for new NBI systems, we will be able to routinely use NBI when withdrawing the colonoscope to detect more lesions. In this paper, we would like to introduce techniques to detect small colorectal adenomas using NBI in our clinic.