食道炎に伴う接合部病変―癌と鑑別を要する隆起，陥凹

Esophago Gastric Junctional Cancer, Esophageal Cancer, Esophagitis, Papilloma, Esophageal Cardiac Gland

要旨　食道胃接合部には発赤や出血，陥凹，隆起，狭窄など，様々な病変が発生する．また，食道胃接合部には扁平上皮癌と腺癌の両方が発生し得るため，その鑑別診断は非常に複雑である．炎症が強い時期に採取された生検では炎症異型が強いため，組織学的な診断が困難なことがある．したがって，むやみに生検を繰り返しても正診に至ることは難しい．内視鏡医はPPI投与後に拡大内視鏡を用いて再検する配慮が求められる．その際，PPIを投与すると炎症は治まるが，癌が扁平上皮に覆われることがあるため，扁平上皮下の所見を追究する努力が必要である．本稿では炎症性ポリープ，乳頭腫，びらん，露出型食道噴門腺，Barrett食道癌を提示し，食道胃接合部癌との鑑別を解説した．

　There are a lot of lesions in the esophago gastric junction, for example, redness, erosion, inflammation polyps, stenosis, junctional cancer and Barrett's esophageal adenocarcinoma.

　Furthermore, not only adenocarcinoma but also squamous cell carcinoma was found in this area. Therefore, the differential diagnosis is difficult.

　The endoscopic diagnosis of junctional lesions is difficult when the patient has severe esophagitis. The pathological diagnosis of the biopsy specimens taken from junctional lesion with severe esophagitis is also difficult because of inflammatory atypia. Random biopsies taken from inflammatory lesions sometimes cause misdiagnosis. Therefore, the endoscopists should recheck the patients after the treatment with PPI. Sometimes, the lesion was covered by non-neoplastic squamous cell epithelium after PPI treatment. Therefore, the endoscopist must try to observe a subepithelial adenocarcinoma. Inflammatory polyps, junctional erosion, papilloma, esophageal cardiac gland,Barrett's esophageal adenocarcinoma were shown in this paper.