Sessile serrated lesion with dysplasia（SSLD）の内視鏡診断と治療

Endoscopic Diagnosis and Treatment of Sessile Serrated Lesion with Dysplasia（SSLD）

要旨●SSLDの内視鏡診断は，拡大観察によりある程度診断可能であるが，SSLを含めた治療適応，取り扱いについては明確な基準はない．当センターでは以前より，異なる表面構造を認めた際に治療を行う方針としているが，今回，ごく軽度の表面構造の変化を“大開II型”と仮称し検討を行ってみた．結果は病理組織学的にはSSLとSSLDは約半数ずつであり，内視鏡観察でより鋭敏に組織の変化を捉えられる可能性もあると考えた．また当センターの切除例で均一な表面構造のみの病変には1例もSSLDは認めず，一方で発見が困難な病変が存在する事実もあり，詳細な内視鏡観察を優先し，表面構造に変化を認めた際に治療するという方針も選択肢の一つと考える．

　There are no clear guidelines regarding the treatment indications and management of a sessile serrated lesion with dysplasia（SSLD）, including sessile serrated lesions（SSLs）. At our center, we selectively treat SSL lesions when different surface structures are observed. In this study, we provisionally referred to a mild surface structure change as a “large Type-II open pit pattern”. Pathological examination of the included specimens demonstrated that approximately half of them were SSL ; the other half were SSLD. This indicates that endoscopic observation may detect pathological changes more sensitively than histopathological examination. Additionally, at our center, none of the resected lesions with uniform surface structures were diagnosed as SSLD. Because it is challenging to detect all lesions, we propose prioritizing a detailed endoscopic observation and treating lesions with surface structure changes as a possible approach for the management of SSLDs.