| セッション情報 | International Session7(消化器内視鏡学会・消化器病学会合同)Small bowel endoscopy-Where are we,and where to go? |
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| タイトル | IS7-基調講演2：Small-bowel endoscopy: where are we, where to go? |
| 演者 | J.-F. Rey（Institut Arnault Tzanck） |
| 共同演者 | |
| 抄録 | Background: Since 2002, H. Yamamoto opened a new era with the development of double-balloon enteroscopy (DBE). Simultaneously Given Imaging introduced the small-bowel capsule opening a new era in digestive diagnosis and increasing requests for small-bowel therapeutic endoscopy. At that stage, Push enteroscopy became obsolete. Then, in 2005 simultaneously in Japan and France, K. Ohtsuka and ourselves have introduced single-balloon enteroscopy (SBE). Both techniques have been published and compared in expert hands with impressive results compared to the past. But, in routine, for most of endoscopy units, it is still a time consuming examination. Aim: The goal of this lecture is to enhance the future potential benefit of small-bowel endoscopy with current technologies and promising technical improvements such as spiral endoscopy (SE). Material: Our personal experience relies on 472 SBE performed since 2005 and 89 SE that we have learnt in 2008 from the Tampico group. All SE have been performed with the commercially available Spirus equipment ® under Propofol sedation. Due to the available device only oral route was possible. Results: DBE and SBE are currently the gold standard for diagnosis and treatment for small-bowel diseases but they are time consuming and have technical limitations due to the size of the biopsy channel. With the SE, deep intubation down to the ileum was possible in 82% of the cases with limitation due to a technical difficulty (sticky jelly blocks the rotation of the spiral system) or patients previous abdominal surgery. But the most impressive effect is the reduced examination time by more than 30%. Currently compare to DBE or SBE, Spirus has contraindications in case of esophageal varices and cannot be used for anal route or Roux-Y ERCP. We observe limited trauma of the esophagus without consequences, of course Spirus device needs a trained assistant as it is rotated manually. All these drawbacks could be solved in a near future by technical improvements. Size of the biopsy channel (2.8 mm) is also a limitation. We used since 4 years a 3.2 mm Olympus prototype with improved therapeutic possibilities. Conclusion: The huge benefit of improving small-bowel examination is a reduced examination time and with more reliable results it could lead in the future to a more worldwide use of SE in routine as therapeutic possibilities with a larger biopsy channel. |
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