早期胃癌EMR後のサーベイランス―遺残再発の早期発見

Surveillance of Early Gastric Cancer after EMR: Early Diagnosis of Local Recurrence

要旨　1983年以降内視鏡的治療を施行した早期胃癌354症例（399病変）のうち，遺残再発を来した病変は89病変（22.3％）であり，内視鏡的治療適応病変での遺残再発は54病変（54/296：18.2％）に対し，非適応病変での遺残再発は35病変（35/103：34.0％）であった．EMR後に局所生検陰性が3か月以上持続し，その後陽性となる症例を25例（6.3％）に認めたが，その生検陰性期間の平均は約9か月で75％が1年以内に陽性化し，陰性期間が2年を超える症例はなかった．これをもとに患者のコンプライアンスを考慮したEMR後のサーベイランスをシステム化した。また，EMR後の遺残再発の早期発見には色素拡大内視鏡検査が有用であり，これによる的確な遺残再発部位の診断が内視鏡的追加治療による根治を容易にすると考えられる．

　There were 354 cases (399 lesions) of early gastric cancer which had been treated by EMR from 1983 and 89 cases (22.3%) had recurrence. Among these cases, there were 54 cases (54/296: 18.2%) which had had the indication for EMR and 35 cases (35/103: 34.0%) which did not have the indication. In 25 cases (6.3%), the biopsy from the local lesion after EMR was negative for more than three months, but it came to be positive after some interval and we called these cases “C group”. The interval in which the biopsy was negative in C group was for about nine months and it came to be positive in 75% cases within one year. There were no cases in which the biopsy came to be positive after being negative for over two years. Using these results we made a follow-up system after EMR relying on the compliance of the patients. Magnifying endoscopy, using a dyeing method was very beneficial for early diagnosis of local recurrence after EMR. We think that we can diagnose the recurrence of lesions in the early stage more precisely by this method and this makes it easier to being about a radical cure by additional endoscopic therapy.