内視鏡的胃粘膜切除術手技の新しい試み―strip biopsy後の方法論をめぐって

Review : Methodological Development of Endoscopic Mucosal Resection after Inventory of Strip Biopsy

要旨　早期胃癌の治療としての内視鏡的粘膜切除術（EMR）について，strip biopsy登場後の展開を論評した．より正確に，より安全に，より大きくという観点から，フード法，EMRC，EAM，EMR-L，4点固定法が開発されている．しかし，早期胃癌に対するEMRの適応は，病理学的所見をもとに基準が考えられており，このため手技の開発論もこの適応基準内での正確，安全な切除に精力が注がれている．適応拡大という面からみれば，これまでの手技の方法論ではこの点の追求はほとんどないが，4点固定法はこの問題を意識した検討がなされている．

　The history of development of endoscopic mucosal resection (EMR) as a treatment for early gastric cancer after inventory of strip biopsy was outlined. For the purpose of more precise, safe, and wide resection, following 4 methods have been developed ; the hood method, EMRC method, EAM method, EMR-L method, and fixing four points method. Indication of EMR for early gastric cancer is determined by the pathological findings, therefore, the methodological development has been limited within this indication and aimed at more precise and safe resection. From the viewpoints of widening the indication of EMR, there have been a few research and development by the previous methodological approach except for the fixing four points method.