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Stomach and Intestine(Tokyo) Volume 36, Issue 5 （April 2001）

胃と腸 36巻5号（2001年4月発行）

Japanese English

今月の主題早期の食道胃接合部癌

主題

食道胃接合部癌の治療―EMRの適応 Endoscopic Mucosal Resection for Esophago-Gastric Junctional Cancer 小山恒男 ¹ , 宮田佳典 ¹ , 友利彰寿 ¹ , 堀田欣一 ¹ , 島谷茂樹 ¹ , 山田繁 ¹ , 比佐岳史 ¹ , 古武昌幸 ¹ , 高松正人 ¹ , 都甲昭彦 ² Tsuneo Oyama ¹ , Yoshinori Miyata ¹ , Akihisa Tomori ¹ , Kin-ichi Hotta ¹ , Shigeki Shimaya ¹ ¹佐久総合病院内科 ²佐久総合病院外科 ¹Department of Gastroenterology, Saku Central Hospital キーワード： esophago-cardiac junctional cancer , EMR Keyword: esophago-cardiac junctional cancer , EMR pp.683-688

発行日 2001年4月25日 Published Date 2001/4/25

DOI https://doi.org/10.11477/mf.1403103214

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要旨　食道胃接合部癌のEMRは常に接線方向からのアプローチになり視野が悪く，内腔が狭いため内視鏡の操作に制限があり，他部位のEMRより難しい．通常観察では病変の全体像を一視野に捉えることは困難だが，内視鏡の先端にフードを装着後に胃，食道腔内の空気を抜くと接合部が食道側に入り込み，見下ろしで観察することができるようになる．接合部病変が小さい場合にはこの状態での先端フード法が有効であるが，病変が大きい場合には従来では計画的分割切除の適応であった．われわれが開発したhooking EMR法は内視鏡視野が悪い接合部病変でも確実な一括切除が可能であった．

　Endoscopic mucosal resection (EMR) for esophagogastric junctional cancer is difficult, because the lumen of the esophago-gastric junction is narrow.

　The strip biopsy method needs to use a two channel scope, but the flexibility and usage of a two channel scope is not so good compared with a single channel scope. So the strip biopsy method is difficult for EMR of junctional cancer.

　If the lesion is accompanied with sliding hernia, U turned or J turned observation is easy and closed observation is possible. So, EMR of a junctional cancer is easy with the EMRC method. But, if the lesion is not accompanied with sliding hernia, closed observation is difficult and EMR using the EMRC method can not be used.

　Endoscopic observation of a cardiac part of a junctional cancer is difficult, because the esophago-gastric junction is narrow. But, the anal part of the junctional lesion moved to the esophageal side when air was removed from the esophageal lumen. So EMR with the EMRC method can be easily performed in this situation.

　Using the ERHSE method, it is difficult to resect the junctional lesion, because the lumen is very narrow and snaring is not possible. But, the new EMR method, hooking EMR, is useful for esophago-gastric junctional cancer. Firstly, we placed marks around the lesion using a coagulation needle. Then, saline diluted epinephrine solution was injected into the submucosal layer to separate the mucosal lesion from the propermuscular layer. Then, we cut the mucosa arround the cancer using a needle knife. Next, we cut the submucosal fibers using a hooking knife and removed the cancer without using a snare.

　EMR of esophago-gastric junctional cancer is difficult compared to that of the gastric cancer, but, it was possible to select an adequate EMR method.