切開・剥離法（ESD）に必要な早期胃癌の術前内視鏡診断―深達度診断を中心に

Invasiveness of Early Gastric Cancer Indicated by Endoscopic Examination

要旨　EMRを念頭に置いて，肉眼型別に内視鏡による早期胃癌の深達度診断について述べた．①隆起型早期胃癌では隆起頂上の深い陥凹，周囲からの粘膜ひだの引き込み，粘膜下腫瘍様の立ち上がりなどがSM浸潤の指標として重要である．②UL(－)平坦・陥凹型早期胃癌では健常粘膜に覆われた周囲隆起がSM浸潤の指標として重要である．③UL(＋)陥凹型早期胃癌では集中する粘膜ひだ先端の肥大・融合，病巣の周囲隆起・台状挙上，面の硬化像がSM浸潤の指標として重要である．

　Diagnostic findings of invasiveness of early gastric cancer penetrating further than the submucosal layer were considered as follows ;

　1 ) Endoscopic examination indicated submucosal invasion in cases of elevated-type gastric cancer with deep depression and/or ulceration on the surface of the tumor. Both mucosal rigidity and submucosal tumor-like　elevation covered with normal mucosa were important findings by endoscopic examination, suggesting submucasal invasion.

　2 ) In the depressed-type early gastric cancer without ulceration or ulcer scar, a surrounding area of normal mucosal elevation on endoscopic examination suggested submucosal invasion.

　3 ) In the depressed type early gastric cancer with ulceration or ulcer scar, swelling and fusion of the mucosal folds at the rim of a depression, elevation around the depression, plate-like elevation, and rigidity of the entire depressed lesion were important findings by endoscopic examination suggesting submucosal invasion.