3)大腸 (1)ポリープ

Endoscopic Treatment for Colorectal Polyps

要旨　ポリープを安全に内視鏡治療するためには，術前の準備として，偶発症に関するインフォームド・コンセントと，抗凝固剤服用の有無の確実なチェックが重要である．手技においては，体位変換やスコープの回転操作などにより病変の基部を5～6時方向に移動させることが重要で，その位置でスネアリング，切断，回収などすべての操作を行う．内視鏡治療が広く行われるようになった現在，偶発症としての出血に対しては局注，留置スネア，クリップ，凝固などにより，穿孔に対しては一度に長く通電しない，局注量を多くするなどして偶発症の予防・対策に努めることが重要である．

　In order to complete endoscopic treatment for colorectal polyps safely, the following issues are important. In preparation for the treatment, it is important to obtain informed consent from the patient, especially about possible complications of endoscopic treatment and to check whether anticoagulant is used or not. Regarding treatment technique, it is important to adequately ascertain the position of the lesions located at the 5 to 6 o'clock position by rotating the scope or changing the patient's position. Successful procedures for snaring, transection and retrieval can be carried out when the position of the lesions is as mentioned above. The most important thing we have to pay attention to is to prevent serious complications of endoscopic treatment such as bleeding and perforation. To prevent bleeding or to stop bleeding, injection to the stalk, detachable loop snare, hemoclip and coagulation therapy are effected. In order to prevent perforation, long-time use of electric cautery or too small an amount of submucosal injection should be avoided.