異時性多発食道癌に対する内視鏡治療―多発小ヨード不染を有するEMR後症例に対するAPCの意義

Endoscopic Treatment for Metachronous Squamous Cell Cancer―Effect of APC on Multiple tiny Iodine-Unstained Lesions After EMR

要旨　食道表在癌に対する内視鏡切除の進歩と適応拡大により食道が温存されQOLの向上が図られてきた．一方，食道が温存されることによりfield cancerizationの問題が挙げられる．内視鏡検査のヨード染色で発見される多発癌や異時性多発食道癌に遭遇する機会も多い．われわれはEMR後経過例の多発小ヨード不染に対してAPCを施行してきた．71例を対象とした検討では，APC前生検では19.7％が扁平上皮癌，43.7％がdysplasiaの診断であった．APC処置後は64.4％の症例で内視鏡所見での明らかな多発小ヨード不染は改善した．経過追跡でヨード不染が残存した16例のうち，10例は生検でも扁平上皮癌と診断され3例に再EMRが施行された．APCは簡便で多発小ヨード不染を有する食道粘膜のメインテナンス法として有用な処置法と思われた．

　Development of endoscopic resection and its larger indication for use in superficial esophageal cancer enabled the preservation of the esophagus and improvement of quality of life after the treatment. On the other hand, the field cancerization in the preserved organ remains. We are encountering increasing opportunities to find multiple cancer lesions and metachronous squamous cell cancer through the use of iodine staining during endoscopic examination. We performed APC on 71 patients with multiple tiny iodine-unstained lesions after EMR, including 19.7％ of squamous cell cancers and 43.7％ of dysplasia. The unstained lesions disappeared after APC in 64.4％ of the treated cases. Of the 16 cases resistant to the APC treatment, 10 cases were shown by biopsy to be squamous cell carcinomas and EMR was performed again. APC is simple and considered to be effective in multiple tiny iodine-unstained lesions of the esophageal mucosa.