真口 宏介, 小山内 学, 高橋 邦幸, 潟沼 朗生, 中原 和之

Hiroyuki MAGUCHI, Manabu OSANAI, Kuniyuki TAKAHASHI, Akio KATANUMA, Kazuyuki NAKAHARA

手稲渓仁会病院消化器病センター

Center for Gastroenterology, Teine-Keijinkai Hospital

キーワード : endoscopic ultrasonography, pancreatobiliary disease, standardization of imaging techniques, EUS guided fine needle aspiration biopsy (EUS-FNAB)

内視鏡下超音波検査(endoscopic ultrasonography：EUS) の利点は, 分解能が高く局所観察能に優れることであり, 各種 画像診断の発展が見られる現状においても胆・膵領域では最も精度の高い診断法の一つである. 特に, 小病変の診断に有 用性が高く, 膵・胆道癌の早期発見に期待が持たれている. しかしながら, 走査手技が難しく術者の育成が課題となって いた. その解決に向けラジアル走査式EUS による膵・胆道領域の標準的描出法が作成され, 日本から世界に発信された. 一方, 欧米に遅れはとったものの超音波内視鏡下穿刺吸引術が本邦でも普及し始めている. このことにより画像診断に加 え細胞診・組織診が可能となった他, 本手技を応用した治療にも発展してきている. EUS は, 内視鏡を挿入するという 被検者への負担はあるものの, 得られる情報量は多く, 広く普及することが望まれる.

The advantage of endoscopic ultrasonography (EUS) is its high resolution and its superior capacity for local observation. It is one of the most accurate diagnostic methods, particularly for the pancreatobiliary region, while advances in various imaging diagnostic methods are seen today. Since it is most useful for diagnosing small lesions, its use for early diagnosis of pancreatobiliary cancer is anticipated. However, the operating techniques are difficult, and education and training of operators has been a challenge. With the aim of solving this problem, standard imaging techniques in the pancreatobiliary region using radial scanning EUS have been established in Japan and published internationally. On the other hand, EUS guided fine needle aspiration is now coming into wide use in Japan, though the practice is behind that in Western countries. Consequently, pathological diagnosis has been made possible in addition to imaging diagnosis, and application of the techniques to treatment is also progressing. As EUS provides much information, it will be necessary to foster a large number of operators.