1）NBI拡大観察が進展範囲診断に有用であった同時多発性Barrett食道腺癌の1例

Synchronous Barrett's Esophageal Adenocarcinoma Diagnosed by NBI Magnified Endoscopy, Report of a Case

要旨　患者は30歳代，男性．検診異常にて行った上部消化管内視鏡検査で，食道病変を指摘された．Barrett食道腺癌の診断は困難なことがあり，また同時多発癌・異時多発癌の発生が多いとも報告されている．本例は，通常観察では主病変の存在診断は可能であったが，さらにNBI拡大内視鏡を行うことで，側方進展範囲診断が容易となった．また，通常観察では発見しえなかった副病変の存在診断にもNBI拡大観察が有用であった．治療としてBarrett粘膜を含む下部～腹部食道全周のESDを行った．デキサメタゾン局注併用バルーン拡張術を要したが，狭窄なく治癒しえた．

　A male in his thirties was referred to our hospital for investigation of an esophageal lesion.

　A shallow depressed lesion was located in the posterior side of the LSBE（long segment of Barrett's esophagus）. The margin was indistinct under white-light endoscopy. However NBI（narrow band imaging）magnified endoscopy showed a well demarcated lesion. Moreover, a synchronous lesion was found by NBI magnified endoscopy. We performed circumferential ESD（endoscopic submucosal dissection）of the whole Barrett's esophagus. Pathological diagnosis of the main and sub lesion was 34×17mm, type 0-IIa＋IIb, well differentiated adenocarcinoma,T1a-DMM, ly0, v0, pHM0, pVM0, and 6×5mm, type 0-IIc, well differentiated adenocarcinoma,T1a-M, ly0, v0, pHM0, pVM0. 15 times balloon dilatation with steroid injection was performed to prevent stricture, and it showed that the ESD ulcer covered squamous epithelium without stricture. A circumferential ESD is an option for the treatment of Barrett esophageal superficial cancer. Intestinal mataplasia was evidenced in only about 25％ in Barrett's esophagus.