4)大腸 (1)スネア法

Method of Endoscopic Mucosal Resection by Using Snare Device

要旨　スネアを用いた内視鏡的粘膜切除術（endoscopic mucosal resection ; EMR）は，現在では大腸内視鏡治療の基本手技になっている．被検者へのインフォームド・コンセント，EMRの適応を考慮した上で行わなければならないが，大腸では壁厚が薄く，柔軟であるため穿孔などの偶発症も危惧される．そのため術者は，基本的事項としてスネアの選択，位置取り，局注およびスネアリングの仕方を熟知した上で，謙虚な姿勢を守り，的確な手順を踏むことで安全にEMRを行うことが可能である．また適切な切除標本の取り扱いも正しい病理診断を得るために重要である．EMRの目的は単なる切除ではなく，患者利益に繋がることを肝に銘じておく必要があると考える．

　Recently the EMR method has become the basic technique for colonoscopic therapy. However, it is very dangerous because the wall of the colon is thin and soft. Accordingly, endoscopists have to obtain informed consent from patients, and discover how to adapt EMR for their neoplastic lesions. They also have to be well aware of the basic important steps in EMR, e.g. selection of a suitable snare, positioning of the colonoscope, how to carry out injection and snaring, and how to deal with the excised species etc.

　They need also to avoid an attitude of overconfidence, considering that the purpose of EMR is not just excision, but also to benefit the patient for the future.