| セッション情報 | パネルディスカッション7カプセル内視鏡の臨床応用，新たな展開 |
|---|---|
| タイトル | PD7-基調講演：Developments of capsule endoscopy in a clinical setting：To a new dimension |
| 演者 | Spada Cristiano（Digestive Endoscopy Unit, Catholic University, Italy） |
| 共同演者 | |
| 抄録 | Capsule endoscopy（CE）was introduced as a novel method for direct exploration of the mucosa of the small bowel（SB）. Several studies have shown that it is a useful diagnostic modality for SB disorders since it allows an endoscopic, noninvasive SB visualization. Usefulness of CE in patients with obscure gastrointestinal bleeding（OGIB）, Crohn’s Disease（CD）, Tumors and Polyposis has been extensively reported. Development of CE has revolutionized the diagnostic and therapeutic approaches for patients with SB diseases. Nevertheless, some issues need still to be clarified. Sensitivity, specificity and predictive values of CE in patients with OGIB and CD are not truly known because there is no standard comparative method. In particular, studies evaluating accuracy parameters（sensitivity, specificity, PPV, NPV, likelihood ratios）of CE in OGIB（occult and overt）patients are lacking. The outcome that is usually reported in OGIB patients is diagnostic yield（DY）, often without differentiating OGIB as occult vs. overt subtype. The overall DY of CE is approximately 60%. DY of CE in OGIB patients is higher when compared to other diagnostic modalities. Nevertheless, it seems that there is room for DY improvement. In this sense, timing of CE and selection of patients seem to be crucial in order to increase the outcome and DY. There have been a number clinical factors reported to be associated with a higher DY at CE in patients with OGIB. These include：ongoing active bleeding at the time of CE（overt and occult）, increasing age, the use of warfarin, liver comorbidity, higher number of precapsule EGDs or blood transfusions, or underlying connective tissue disease. In the context CD, CE has been shown to have a consistently high sensitivity and NPV（range 96-100%）. However, the lack of a gold standard for the diagnosis of CD hinders precise definition of CE accuracy and ‘diagnostic yield’ for findings consistent with CD has often been adopted as a ‘surrogate’ in the appropriate clinical context. Furthermore, the mucosal inflammatory changes which are found in active SB CD, are not specific to this disease. The high diagnostic yield of CE versus other imaging modalities may therefore not directly translate into a higher diagnostic accuracy since lesions detected by CE may also be induced by other aetiologies. Main topic of Keynote Lecture will be a critical review of the literature, referring to the forthcoming new guidelines of the European Society of Gastrointestinal Endoscopy on enteroscopy. |
| 索引用語 |