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Stomach and Intestine(Tokyo) Volume 44, Issue 4 （April 2009）

胃と腸 44巻4号（2009年4月発行）

Japanese English

特集早期胃癌2009

主題 6．早期胃癌の治療

3）ESDによる早期胃癌の治療 Endoscopic Submucosal Dissection for Early Gastric Cancer 小山恒男 ¹ , 高橋亜紀子 ¹ , 北村陽子 ¹ , 友利彰寿 ¹ , 堀田欣一 ¹ , 宮田佳典 ¹ Tsuneo Oyama ¹ , Akiko Takahashi ¹ , Yoko Kitamura ¹ , Akihisa Tomori ¹ , Kin-ichi Hotta ¹ , Yoshinori Miyata ¹ ¹佐久総合病院胃腸科 ¹Department of Gastroenterology, Saku Central Hospital, Saku, Japan キーワード：早期胃癌 , ESD , ESD適応 , ESD適応拡大 , 長期予後 Keyword: 早期胃癌 , ESD , ESD適応 , ESD適応拡大 , 長期予後 pp.686-693

発行日 2009年4月24日 Published Date 2009/4/24

DOI https://doi.org/10.11477/mf.1403101640

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要旨　ESDは占居部位，形，大きさにかかわらず一括切除が可能な優れた内視鏡治療手技であるが，適応拡大病変に対するESDの安全性，長期予後は不明であった．本稿では第75回日本消化器内視鏡学会総会シンポジウム「早期胃癌適応拡大病変に対するESDの現状と問題点」にて集計された，予後把握率90％を超えた12施設のデータを元に適応拡大病変に対するESDの治療成績を検討した．適応内群9,033例，適応拡大分化型群4,207例，適応拡大未分化型群256例で，一括完全切除率はそれぞれ94.5％，86.4％，90.9％，現病死は0.01％（1/9,033例），0.02％（1/4,207例），0.4％（1/256）であり，各群間に優位差はなかった．これらはいずれもレトロスペクティブな検討だが，予後捕捉率90％以上の多施設からのデータ集計であり，現時点で胃癌に対するESDの適応拡大基準は妥当と思われた．

　Endoscopic mucosal resection（EMR）is a simple and safe method for the treatment of early gastric cancer. However, the size of a resected specimen is small, and piecemeal resection should be performed for a large lesion. Precise pathological diagnosis is difficult in piecemeal resected cases, and the local recurrent rate is higher in piecemeal resected cases compared with en bloc resected cases. Because of this,ESD was developed.

　The long term prognosis of early gastric cancer treated by ESD was investigated by 14 hospitals for the meeting of the Japan gastroenterological society. The patients were divided into three groups ; the indication group（well differentiated adenocarcinoma, mucosal, without ulcer and 2cm or less in size）, the extended indication group 1（well differentiated adenocarcinoma, mucosal, without ulcer and 2.1cm or more in size）,（well differentiated adenocarcinoma, mucosal, with ulcer and 3cm or less in size）or（well differentiated adenocarcinoma, 500 micrometer or less submucosal invasion and 3cm or less in size）and the extended indication group 2（poorly differentiated adenocarcinoma, mucosal, without ulcer and 2cm or less in size）.

　The numbers of the indication, extended indication 1, and extended indication 2 group were 9033,4207 and 256, respectively. R0 resection rate（en bloc and with a negative lateral margin）in each group was 94.5%,86.4% and 90.9% respectively. Death through gastric cancer occurred at a rate of 0.01%（1/9,033）,0.02%（1/4,207）and 0.4%（1/256）. The long term prognosis of early gastric cancer treated by ESD was good, and the extension of the indication was considered as acceptable.