標準的適応における胃癌EMRの成績

Outcome after Using EMR According to Standard Guidelines for Endoscopic Treatment of Early Gastric Cancer

要旨　標準的適応（2cm以下の潰瘍を伴わない，分化型の粘膜内癌）に対する，EMR各術式の開発者を中心とした成績を検証し，EMRの意義と現状での問題点について考察した．これらの報告によると標準的適応に対する一括切除率は腫瘍長径10mm以下62.8～87.2％，11～20mm 42.1～73.7％と満足すべきものではないが，20mm以下の病変に対する完全切除率は一括切除例で84～100％，分割切除例で71.4～94.1％とおおむね良好であった．遺残再発率は1.7～11.9％であり，これらに対して外科手術が施行されたm癌では全例リンパ節転移は認められず，内視鏡の追加治療例でも局所根治が得られている．合併症では出血の頻度は1.3～20％と術式，報告者により異なるが，内視鏡的止血法や保存的治療で全例止血可能であり，また穿孔はcutting法は高率であるが，それ以外の方法では0.8％以下と低率であった．strip biopsy法や吸引法は標準的適応に対しては安全な根治的治療法であると位置づけられる．

　We reviewed the outcome after EMR according to standard guidelines for endoscopic treatment of early gastric cancer (differentiated carcinoma, a maximal diameter of 20 mm, without ulcerative change) with special reference to the methods of procedure reported by several investigators. En bloc resection rates were 62.8%～87.2% and 42.1%～73.6% in lesions of 10 mm or less and 11～20 mm, respectively. Piecemeal resection con-tributed to a higher complete resection rate (71.4%～94.1%) and prevented cancer recurrence following EMR. The recurrence rate after EMR was 1.7%～11.9%. Twenty-seven of 99 cases with recurrent lesions after EMR underwent surgical operations, which revealed mucosal residual cancer with no lymph node metastasis. The other 72 lesions were locally cured by additional endoscopical treatments. The complications of EMR were bleeding (1.3%～20%) and perforation (0.8% or less by procedures other than cutting) . The bleeding was completely controlled by endoscopic treatment, but the perforation required surgery. When the outcomes after EMR by different methods are viewed comparatively, the strip biopsy method and aspiration methods are safe and provide curative treatments as modalities of EMR according to standard guidelines for endoscopic treatment of early gastric cancer.