Barrett食道癌の内視鏡診断―拡大内視鏡を併用した側方範囲診断

Diagnosis of Lateral Extension of Barrett's High Grade Dysplasia using Magnified Endoscopy

要旨　2000年11月から2011年3月までに内視鏡的粘膜下層剝離術（endoscopic submucosal dissection ; ESD）にて治療したBEA（Barrett's esophageal adenocarcinoma）30例，36病変を対象とし，側方進展範囲診断を検討した．側方進展範囲は拡大内視鏡で行い，全例が一括切除された．割入り標本の実体顕微鏡像上に癌の範囲をマッピングし，内視鏡像と対比することで内視鏡上の側方進展範囲を確認した．主肉眼型は0-I型が7病変，0-IIa型が17病変，0-IIb型が4病変，0-IIc型が8病変であった．純粋な0-IIb型を除く32病変中16例（50％）でIIb進展を合併し，その範囲は5（1～53）mmであった．通常内視鏡での随伴IIb診断率は25％（4/16）であったが，拡大観察では94％（15/16）であった．36病変中30病変（83％）がSCJ（squamocolumnar junction）と接していた．このうち13病変は扁平上皮下を口側へ進展し，その平均距離は4.3（最大9）mmであった．扁平上皮下進展を示唆する所見としてSMT様の厚み，扁平上皮下の異常血管透見，扁平上皮の小孔が挙げられたが，所見のない病変も3例（23％）存在した．

　Thirty six lesions of BEA（Barrett's esophageal adenocarcinoma）from thirty patients were treated by ESD（endoscopic submucosal dissection）from Nov. 2000 to March 2011. All BEA were diagnosed by magnified endoscopy, and En bloc resection was performed. The macroscopic type of BEA was as follows ; 0-I : 7,0-IIa : 17,0-IIb : 4,0-IIc : 8, and 16 lesions had IIb spreading. Four cases of the 16 IIb spreading were diagnosed by conventional endoscopy, and 15 of 16 were diagnosed by magnified endoscopy.

　Thirty BEA were in contacted with the SCJ（squamocolumnar junction）. Thirteen of 30 BEA had extended to the oral side under SCE（squamous cell epithelium）, and the average distance was 4.3mm（max 9mm）. Endoscopic findings of the extension under SCE were submucosal tumor-like thickness, permeation of abnormal vessels and small depressions. However,23％（3cases）didn't show such findings.