INTESTINE Vol.25 No.4(4-1)


特集名 大腸Ⅱc─革命のその後
題名 拡大内視鏡診断が大腸Ⅱc,陥凹型病変にもたらしたもの (1) Pit patternの立場から
発刊年月 2021年 12月
著者 藤井 隆広 藤井隆広クリニック
【 要旨 】 1985年頃,大腸Ⅱcは“幻の癌”から“実在の癌”へと認識が変わった.そのⅡcの特徴として実体顕微鏡観察からⅢS型pitの存在が明らかになり,新たな工藤pit pattern分類が提唱された.1993年に製品化されたズーム式拡大内視鏡は,ⅢS型pitを含め,生体内での認識を可能とした.拡大内視鏡によりⅡcを含め,pit pattern分類から全ての大腸腫瘍性病変に対し病理診断に近いレベルの内視鏡診断が可能となり,診断から治療までを1回の検査で完遂できるに至った.まさに,この頃が大腸内視鏡の革命期といえる.その後,NarrowBand Imaging(NBI)の画像強調装置が開発され,このNBIと拡大内視鏡の併用がⅡcの存在,質的,量的診断に大きく貢献してきた.今後は,若手内視鏡医による好奇心と探究心からⅡcの実態解明に向けた新たな診断への革命が期待される.
Theme Depressed type colorectal cancer -- Revolution and since then
Title What relevance has magnifying colonoscopy to IIc neoplastic lesion? From the view-point of pit pattern
Author Takahiro Fujii TF Clinic
[ Summary ] With the status shift from "phantom" to "real" carcinoma, stereomicroscopy has characterized colorectal IIc neoplastic lesions to have a ⅢS pit pattern, leading to the revision of the Kudo's pit pattern classification for colorectal neoplasms. In this regard, zoom magnifying colonoscope was made available in 1993 for clinical use and has since enabled the ⅢS pit to be diagnosed in vivo, marked a revolutionary advance as it has enabled not only the detection but also qualitative and quantitative diagnosis of all neoplastic colorectal lesions including IIc lesions; this breakthrough diagnostic modality allows for the diagnosis and treatment of these lesions in one visit. Further, combined with narrow-band imaging (NBI), a new image enhancement technology that became available later, magnifying colonoscopy has contributed to the detection and qualitative diagnosis of colorectal IIc lesions. In the years to come, it is eagerly hoped that young endoscopists will contribute to breakthroughs in colorectal cancer diagnosis, enabling further elucidation of colorectal IIc lesions.
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