2)食道 (2)キャップ法

Endoscopic Mucosal Resection Using a Cap―For Early Esophageal Cancer

要旨　食道表在癌に対する内視鏡治療の1つとしてEMRC（キャップ法）は開発されたが，その簡便さから，あらゆる消化管領域で利用されている．外径18mmのソフトキャップにて1/3周性，長軸方向に2cmまでの病変は一括切除が可能である．広い病巣の分割切除の場合は局所再発が起きる可能性が高いが，遺残を疑う部分に，APC焼灼を加えることで補っている．広く取りすぎると高度の狭窄を来し，QOLを損なう場合や後治療に影響する場合があり，食道癌の場合はこの点にも注意して治療しなければならない．手技は比較的簡単だが，吸引の加減で水平，深部の大きさが規定され，切除が盲目的となるため，1％程度の可能性ではあるが，穿孔には十分な注意が必要である．

　Endoscopic mucosal resection using a cap (EMRC) is one of several local treatments for superficial esophageal cancer. By the EMRC procedure, mucosa can be easily accessed at any part of the gastrointestinal tract. Lesions were removed using a transparent plastic soft cap by inserting a needle close to the lesion and injecting an adequate volume of saline solution containing diluted epinephrine beneath the epithelium to lift it above the surrounding mucosa.

　EMRC allowed us to resect a tumor with a diameter less than 2 cm in size, or less than one-third of the circumference.

　Piecemeal resection involves a risk for local recurrence, so we sometimes apply additionally an argon plasma coagulation.

　Circumferential resection frequently resulted in severe esophageal stenosis, which decreased the quality of life of the patient. One of the important EMRC procedures is to control the power of suction, because it determines the size of the tumor and also makes the technique difficult. The most serious complication would be perforation (1％), we must take care so that this will not happen.