食道胃接合部腺癌の通常内視鏡診断―通常内視鏡の立場から─臨床病理学的事項に基づいて

Diagnosis of Adenocarcinoma of the Esophagogastric Junction by Conventional Endoscopy

要旨　近年，欧米では噴門部すなわち食道胃接合部における癌の発生率が急速に増加し，白人男性においては胃癌全体のほぼ半数を占めるに至った．一方，本邦では依然として非噴門部癌が多く，噴門部癌の割合は低い．しかし，本邦でも胃食道逆流症が増加しており，食道胃接合部癌の発生率の増加が危惧されている．そこで，本稿では初期の食道胃接合部腺癌の臨床病理学的事項を検討した．その結果，食道胃接合部腺癌は，高齢男性において，中等度以上の萎縮性胃炎を背景とし，食道胃接合部直下小彎に多く認められた．その形態が陥凹型の場合はほとんどが発赤調であり，隆起の場合は発赤調もしくは褪色調のいずれも呈しうることがわかった．また，高率に重複癌を伴っており，食道胃接合部腺癌を認めた際には，胃全体を注意深く観察する必要があると考えられた．

　Recently, the incidence of adenocarcinoma of the gastric cardia and the esophagogastric junction, in the United States and most Western countries has increased rapidly. Gastric cardia cancers now account for nearly half of all stomach cancers among white males. On the other hand, rate of noncardia cancer is still higher than that for cardia cancer in Japan. However, there might be a tendency for an increase in the incidence of the adenocarcionoma of the esophagogastric junction（AEG）, because the prevalence of reflux esophagitis is increasing in Japan. In this article, the authors investigate the clinicopathological findings of the AEG in the early stage. In conclusion, AEG often arises at the lesser curvature below the esophagogastric junction among old males with moderate to severe atrophic gastritis. In relation to the macroscopic type and the color, almost all of the depressed types are red ; the protruded types are either red or white. There is also a tending to have the other cancers in the stomach. Therefore we should make a minute observation of the whole stomach in the case of AEG.