1）EMR/EPMR

Treatment for Early Colorectal Cancer─EMR/EPMR

要旨　EMR/EPMRは，単なる手技のみの問題ではなく，治療前の診断から治療後の病理診断まですべてを含めた一連の処置として理解する必要がある．SM深部浸潤癌は，リンパ節郭清を含めた外科手術が必要であり，安易に内視鏡治療をすべきでない．深達度予測のためには病変の慎重な観察が重要で，拡大内視鏡を用いたpit pattern診断やNBIは有用である．適切な病理組織学的診断を得るためには，最深部と思われる部位の組織切片が必要であり，切除標本の適切な張り付けや，実体顕微鏡を用いての割入れなどが重要である．

　EMR/EPMR（endoscopic mucosal resection/endoscopic piecemeal mucosal resection）is not just a matter of endoscopic technique but should be well understood as including a whole process from endoscopic prediction of histology before treatment to pathological evaluation of the specimen after resection. Such lesions as predicted to be massively invading the submucosal layer should not be resected endoscopically but should be treated surgically, associated with nodal dissection. Careful observation is important for the prediction of cancer depth and pit pattern or vascular pattern analysis with magnification is very useful for that purpose. The tissue slice of the deepest part of the cancer is necessary for an accurate pathological diagnosis. In order to obtain such a slice, it is important to spread and pin the resected specimen and to cut it under stereomicroscopic observation.