胃癌EMR後のサーベイランス―遺残再発の実態とその診断

Surveillance after Endoscopic Mucosal Resection of Early Gastric Cancer: The Present State and Early Diagnosis of Cancer Residue

要旨　EMR後1年以上経過観察がなされた早期胃癌症例165病変（絶対適応136病変，相対適応29病変）を対象に，遺残再発の実態について検討し，サーベイランスのあり方について考察した，①遺残再発率は絶対適応5.1％（7/136），相対適応13.8％（4/29）であった．②絶対適応病変の一括完全切除例，相対非完全切除例には遺残再発はみられなかった．絶対非完全切除例に遺残再発がみられたが，切除法，非切除法を追加することによりすべて局所治癒した．③遺残再発の診断は治療終了後1年以内になされた．その内視鏡所見は通常内視鏡像では易出血性，色調の変化などであり，コントラスト像では異常発赤顆粒，びらん様小陥凹，色素の“のり”の悪さ，小区の消失などであり，すべて深達度mの所見と推定された．④治療後のサーベイランスは絶対適応の一括完全切除例は3，12か月，以後は年1回，その他の例は日本消化器内視鏡学会内視鏡治療効果判定委員会が定めた規約に準じて1，2，3，6，(9)，12か月後，以後は年1回，異時性癌の発生も念頭に置き，可能な限り長期間継続する．

　We clarified the characteristics of cancer residue after endoscopic mucosal resection (EMR) of early gastric cancers and reported the results of surveillance after endoscopic treatment. One hundred and sixty-five lesions (136 lesions with absolute indication, 29 with relative indication) with early gastric cancers were followed up endoscopically for more than one year after EMR.

　The results were as follows:

1) The rates of cancer residue were 5.1% in lesions with absolute indication and 13.8% in those with relative indication.

2) There was no cancer residue in lesions judged histopathologically as complete resection and relatively incomplete resection.

3) Cancer residue was diagnosed less than one year after treatment in all lesions.

4) It is necessary to carry out careful endoscopic examination 1, 2, 3, 6, 9, and 12 months after treatment (the 9th month check may be omitted, if judged as unnecessary), and thereafter, once annually at least for five years, paying special attention to the findings of abnormal reddish granules, small depression similar to erosion, or mucosal discoloration, etc.