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食塊による食道閉塞プロトコール

完全閉塞しており唾液が飲み込めない、食塊内に鋭利なものが存在する、これらの場合は可能であれば2時間以内、少なくとも6時間以内の早急な内視鏡での解除が求められる。

出典

1: 著者提供

Food bolus impactionの内視鏡像

食道に食塊が詰まった内視鏡像。食道粘膜に気管様多発輪状狭窄を認め、基礎疾患として[Disease:1571 好酸球性食道炎]の存在が疑われる。

出典

1: Goldman et al: Goldman’s Cecil Medicine, 24th edition. Saunders, 2012; Figure136-6

オーバーチューブの概観

（食塊内に骨など鋭利なものが存在する場合に、）オーバーチューブを用いて、食道粘膜の保護を図る。

出典

1: http://www.sumibe.co.jp/product/medical/endoscope/flexible-overtube/index.html (咽頭部通過用ガイドチューブ, 住友ベークライト株式会社)

食道の生理学的狭窄部位について

3 カ所の生理学的狭窄部位として、輪状軟骨後方でC-6 椎体レベルの上部食道括約筋部（UES）、遠位大動脈弓下行部でT-4 椎体レベルの中部食道部、下部食道括約筋部（LES）がある。

成人ではLES部が最も狭い。

出典

1: Foreign bodies in the gastrointestinal tract and anorectal emergencies.

著者: Anderson KL, Dean AJ.

雑誌名: Emerg Med Clin North Am. 2011 May;29(2):369-400, ix. doi: 10.1016/j.emc.2011.01.009.

Abstract/Text: Of all ingested foreign bodies (FBs) brought to the attention of physicians (probably a small minority of the total), 80% to 90% pass spontaneously; however, 10% to 20% require endoscopic removal, and about 1% require surgery. The article divides the GI tract into regions in which the anatomy, presentation, clinical findings, and management of FBs are distinct. The final third of this article describes the management of anorectal emergencies. An understanding of anatomy and common pathological conditions allows the emergency physician to make a diagnosis and provide relief and/or resolution in most cases.

Copyright © 2011. Published by Elsevier Inc.

Emerg Med Clin North Am. 2011 May;29(2):369-400, ix. doi: 10.1016/j.em...

好酸球性食道炎の内視鏡像

aは好酸球性食道炎患者における鶏肉塊による食道閉塞である。気管様の多発輪状狭窄と白斑が特徴的である。 bでは好酸球性食道炎の特徴でもある縦走溝や白斑を認める。

好酸球性食道炎の内視鏡像を示す。

c：正常食道、d：縦走溝を認める、e：気管様の多発輪状狭窄を認める、f：白斑を認める。

出典

1: Foreign bodies.

著者: Smith MT, Wong RK.

雑誌名: Gastrointest Endosc Clin N Am. 2007 Apr;17(2):361-82, vii. doi: 10.1016/j.giec.2007.03.002.

Abstract/Text: The spectrum of gastrointestinal (GI) foreign bodies includes food bolus impaction in the esophagus, nonfood objects that are swallowed, and various objects that may be inserted into the rectum. The risk depends upon the type of object and its location. Fortunately, 80% to 90% of ingested foreign bodies will pass without intervention. Objects with sharp edges or pointed tips have the highest risk of complications, up to 35%. All objects impacted in the esophagus require urgent or emergent treatment. Rectal foreign bodies are usually removable transanally, although general anesthesia and operative intervention sometimes are required.

Gastrointest Endosc Clin N Am. 2007 Apr;17(2):361-82, vii. doi: 10.101...

2: Eosinophilic esophagitis: diagnosis and management.

著者: Lieberman JA, Chehade M.

雑誌名: Immunol Allergy Clin North Am. 2012 Feb;32(1):67-81. doi: 10.1016/j.iac.2011.11.006. Epub 2011 Dec 16.

Abstract/Text: Eosinophilic esophagitis is a clinicopathologic disease that can present with a constellation of upper gastrointestinal symptoms and endoscopic findings in conjunction with significant infiltration of the esophageal tissue with eosinophils. Clinical and histologic resolution of the disease can be seen with dietary restriction therapies and systemic and topical corticosteroids. Because most patients have an atopic background and the disease seems to have an underlying T-helper type 2 pathogenesis, allergists and gastroenterologists need to be familiar with the diagnosis and management of this disease. In this review, clinical characteristics, endoscopic and histologic findings, and available therapy options are discussed.

Copyright © 2012 Elsevier Inc. All rights reserved.

Immunol Allergy Clin North Am. 2012 Feb;32(1):67-81. doi: 10.1016/j.ia...

食道異物、異物誤飲における内視鏡のタイミング適応

ASGEガイドラインによる食道異物における内視鏡のタイミング適応。

赤字部分がfood bolus impactionに関連し、早期の内視鏡が求められている。

出典

1: Management of ingested foreign bodies and food impactions.

Gastrointest Endosc. 2011 Jun;73(6):1085-91. doi: 10.1016/j.gie.2010.11.010.