小腸内視鏡の現況 CURRENT STATUS OF ENTEROSCOPY

小腸は消化管の中でも最も内視鏡検査が困難な臓器でありこれまで行われてきた小腸内視鏡検査法は決して満足のいくものではなかった.しかし,近年全小腸を観察しうる内視鏡検査法としてカプセル内視鏡とダブルバルーン内視鏡という二つの新たな方法が開発され小腸内視鏡検査も新しい時代を迎えることとなった.　このうちダブルバルーン内視鏡はわれわれが考案した新しい内視鏡挿入法,double-balloon methodに基づきフジノン株式会社によって開発された深部小腸における内視鏡検査をも可能とした電子内視鏡システムである.　ダブルバルーン内視鏡の最大の特徴は腸管を短縮把持しながら内視鏡を挿入することによる優れた深部挿入性とバルーンで腸管を把持して安定化させることによる優れた操作性にある.　ダブルバルーン内視鏡は経口的にも径肛門的にも小腸内への深部挿入が可能であることが示され,全身麻酔を必要とせず小腸全域における内視鏡検査,治療が可能となったと報告されている.これまでの報告では合併症率も低く安全性にも優れ,小腸出血をはじめ小腸腫瘍,小腸狭窄,ポリポーシス症候群などの診断,治療における有用性が示されている.ダブルバルーン内視鏡は従来のプッシュ式小腸内視鏡,術中小腸内視鏡検査に代わり,小腸内視鏡のスタンダードとなる可能性が考えられる.今後カプセル内視鏡と共に小腸疾患の診療における重要な役割を担っていくと思われる.

The small intestine is one of the most difficult organs in the gastrointestinal tract for performing endoscopy, and the method of enteroscopy so far has never been satisfactory. However, two new methods, capsule endoscopy and double-balloon endoscopy, have recently been developed to observe the entire small intestine, which is leading us to a new era for enteroscopy. The double-balloon endoscope is an electronic endoscope system developed by Fujinon based on the double-balloon method, a new endoscope insertion method devised by us. It enabled endoscopy even in the distal small intestine. The most remarkable characteristics of the double-balloon endoscope are its excellent ability to reach into deep portions of the small intestine while shortening and holding the intestine and its excellent controllability resulted from stabilizing the intestine by holding with balloons. It has been demonstrated that the double-balloon endoscope can be inserted deep into the small intestine either per os or per anum, and it has been reported that endoscopic diagnosis and treatment in the entire small intestine without general anesthesia have become possible. According to reports to date, the device boasts an excellent safety record with low incidence of complications, and its utility in the diagnosis and treatment of bleeding, tumor, stenosis, and polyposis in the small intestine has been demonstrated. Double-balloon endoscopy may become a standard procedure of enteroscopy, replacing conventional push enteroscopy and intraoperative enteroscopy. Double-balloon endoscopy is expected to play an important role in the management of small intestinal diseases together with capsule endoscopy.