1)上部消化管 (2)粘膜下腫瘍 ② 胃・十二指腸

Endoscopic Treatment for Benign Tumors ― Upper Gastrointestinal Tract：Submucosal Tumor；Stmach, Duodenum

粘膜下腫瘍（submucosal tumor ; SMT）の内視鏡治療には各種の方法が用いられている．腫瘍径が30mm以下の有茎性の例がポリペクトミーの適応である．内視鏡的粘膜切除術（endoscopic mucosal resection ; EMR）は粘膜下層までに病変の主座がある例に用いられる．内視鏡的粘膜下腫瘍核出術（endoscopic scraping enucleation ; ESE）は粘膜下層を主座とし外輪筋が保たれている腫瘍に適応があるとされる．その他に，EMR併用エタノール注入法，純エタノール局注法，レーザー照射による熱焼灼療法も報告されている．いずれにしても消化管壁内での腫瘤の位置を確認することが安全に治療を行う上で重要である．

Various methods are used for endoscopic treatment of submucosal tumors (SMT). Tumors which diameter is equal to or less than 30 mm are suitable candidates for polypectomy. Tumors which main lesion are located within the submucosal layer are suitable for endoscopic mucosal resection (EMR). Tumors which main lesion are located in the submucosal layer and whose outer ring line is kept are suitable for endoscopic scraping enucleation (ESE). In addition, EMR combined with the ethanol injection method, the pure-ethanol localized injection method and the heat cauter treatment by laser radiation are also reported. In any case, it is important that we confirm the position of any mass in the digestive organ wall as a condition for safe treatment of the tumor.