1）EMR

Endoscopic Mucosal Resection for Superficial Esophageal Cancer

要旨　食道表在癌に対する治療方針はEMRの開発により大きく変化した．今日，早期食道癌に対する第1選択の治療法は内視鏡的切除である．筆者らの施設では，幕内らの開発したEEMR-tube法でEMRを行ってきた．また，4-step法により安全な分割切除と遺残再発の予防に努めてきた．従来，EMRでは大きな病巣には分割切除が行われてきた．しかし早期胃癌の治療で普及したESDは食道にも普及し一括切除が行われている．今日，内視鏡的切除として行われているEMRとESDの両手技は病巣の大きさや数，術者技量，所要時間などを考慮しての使い分けが必要と思われる．

　Treatment strategy for superficial esophageal cancer has changed a great deal by developing EMR（endoscopic mucosal resection）.

　ER（endoscopic resection）has now become the treatment of first choice for early esophageal cancer.

　Our standard EMR way is the EEMR-tube method which was developed by Makuuchi et al. And the four-step method is regarded as a very safe maneuver, and is recommended as an effective way to detect local recurrence after EMR.

　A wide lesion can be resected by repeating EMR, but has been recently resected in an en-bloc manner by ESD（endoscopic submucosal dissection）, which was first indicated for gastric cancer.

　Nowadays, which two types of ER,EMR or ESD, should be chosen depends on the size or number of the lesions, the technique of the operator and, the time available, etc.