食道ESDの実際：胃との違いを含めて―Hookナイフ

Safe Esophageal ESD with Hook Knife

要旨　良好な視野を確保し，視認下に処置を遂行することが安全なESDを行う条件である．食道は管腔が非常に狭いため，視野確保がもともと困難なうえに，出血を来すと容易に視野不良となる．術前から十分な治療戦略を練り，このような障害を可能な限り克服する準備が必要である．狭いがゆえにナイフの取り回しにも制限がある．Hookナイフは視認下に組織を把持し，安全な方向に確実に切開することが可能であり，解剖学的な不利を解消できるデバイスである．本稿では，食道ESDを行うに当たっての治療戦略とHookナイフの使用法の実際を解説する．

　To achieve safe ESD, it is essential to maintain a good endoscopic field of view during the procedure. As the esophagus is a very narrow organ, maintaining a good field of view is sometimes difficult. Furthermore in such an environment, bleeding can easily lessen the endoscopic field. To overcome such obstacles peculiar to the esophagus, a well-prepared treatment strategy should be planned before the procedure is undertaken. Because of the narrowness of this organ, device handling is restricted. A Hook knife can grasp tissues under direct vision and enable safe incision or dissection in a safe direction. It can help resolve difficulties posed by the adverse anatomy of the esophagus. In this article, we describe the logic of planning a strategy and the practical use of a Hook knife in esophageal ESD.