内視鏡的食道粘膜切除後のサーベイランス―粘膜切除後潰瘍の治癒経過と問題点

Surveillance of Esophageal Lesions after Endoscopic Mucosal Resection

要旨　内視鏡的食道粘膜切除術後潰瘍の治癒経過を観察する際の問題点について，自験例32例50病巣で検討した．切除後潰瘍は約1か月で再生上皮に覆われた瘢痕となる．再生上皮は時期を追うごとに成熟し，健常上皮に似た白点が規則正しく配列する乳頭パターンが認められるようになる．瘢痕内や周囲に生じるヨード不染帯と局所再燃との鑑別には，通常およびヨード染色時の内部模様の近接，拡大観察が役だつ．局所再燃した3例は半年後に発赤したびらんとして発見された．このうち2例は他臓器の外圧迫で観察が不十分となった病変肛門側に再燃した．同時性，異時性多発例はヨード不染帯がびまん性に拡がる背景粘膜を持つ症例に多い．多発する不染帯から病変を拾い上げる際にも拡大観察が有用である．

　Ulcer healing process after endoscopic mucosal resection (EMR) for esophagus was studied through 50 lesions of 32 cases treated in our department. Ulceration after EMR was cured, but left a scar covered with regenerated epithelium in one month. Regenerated epithelium grew gradually and the papilla-pattern of regularly arranged white spots observed in normal mucosa appeared on the surface. Magnified or close observation was useful to distinguish from local recurrence iodine undyed areas which appeared around scar formation. All of three recurrent cases were detected as a reddening erosion. In two of those cases the recurrent sites were the anal side of the primary lesion where observation was not sufficient because of the outer pressure from neighboring organs. Multiple cases, simultaneous or heterochronous, usually have background mucosa with diffusely scattered iodine undyed lesions. Magnifying endoscopy is also useful to pick up lesions from such multiple undyed spots.