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要旨 咽頭・食道などの扁平上皮領域においては,拡大内視鏡観察の指標としての腺上皮におけるpit patternに当たるものがなく,IPCL(intra-epithelial papillary capillary loop;上皮乳頭内毛細血管ループ)に着目して観察する.このIPCLは,上皮基底層に近接して存在する血管で,傍基底層・基底層の組織変化に相関して特徴的な変化を示すと考えられる.扁平上皮の内視鏡的異型度診断,扁平上皮癌の内視鏡的深達度診断のマーカーになりうると期待される.IPCL Type V-1は“拡張,蛇行,口径不同,形状不均一”の四徴をもって上皮内癌と内視鏡的に診断され,癌の浸潤に伴いIPCL Type V-2,V-3と破壊,腫瘍血管化が進んでゆく.IPCL Type VNはsm深部浸潤癌に特徴的な所見である.拡大内視鏡観察における異常所見からは,実際の癌浸潤はその観察所見に同等のレベルか,それ以深まで及んでいると推測される.拡大内視鏡観察が最大の効力を発揮するのは,平坦な病変に対する内視鏡的異型度診断であり,IPCL Type IV以上の病変を治療対象と臨床判断するところにある.既に,拡大内視鏡観察は通常内視鏡から独立した別個の検査ではなく,スクリーニング内視鏡検査に包括された通常観察の一部となりつつある.
In the esophagus there seems to be no equivalent of pit pattern in the glandular epithelium as an index of structure atypism of the tissue. During magnifying endoscopic observation we pay attention to IPCL (intra-epithelial papillary capillary loop) as a marker for tissue structural atypism. It is considered that the IPCL changes relate to tissue atypism of the para-basal layer/basal layer. IPCL type classification is expected to become not only a marker of the tissue atypism but also a marker of invasion depth. IPCL type V-1 in magnifying endoscopy is diagnosed as carcinoma in situ with a tetrad of dilatation, tortuosity, caliber variation and configuration heterogeneity in IPCL. IPCL type V-2, V-3 demonstrates the breakdown of IPCL according to tumor vascularization advancement with cancer invasion. IPCL type VN is the finding characteristic of deep sm part-infiltration of the cancer. It is supposed that real cancer invasion amounts to the magnifying endoscopic findings at an equal level to it or at a deeper layer. IPCL type classification can be applied significantly to flat lesions as the endoscopic diagnosis of tissue atypism. IPCL type IV and V lesion is a good candidate for treatment by EMR/ESD. Magnifying observation has already been adopted as a part of regular endoscopic observation.
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