胃EMRの適応拡大：大きさからみて―分割切除の工夫と問題点：2チャンネルスコープ法

The Possibility of Extending the Indication for Endoscopic Mucosal Resection of Early Gastric Cancer

要旨　当施設でEMRがなされた胃粘膜内癌205病巣を，大きさ20mm以下のグループA（174病巣），大きさ21mm以上のグループB（31病巣）に分けて検討した．グループBでは切除回数の増加，完全切除率の低下，出血率の増加がみられた．穿孔例はみられなかった．遺残再発はグループAの2.3％，グループBの6.5％にみられたが有意差はなく，グループBでは3分割以上となった23病変においても現在まで癌遺残を認めていない．分割切除による適応拡大にあたっては，正確な粘膜内範囲診断とマーキング，マーキングをすべて含めた切除，厳密な病理組織学的検索，完全切除と判定できない病巣に対する密な経過観察といった一連の流れが確実に行われることが重要である．出血率，遺残再発率の増加といった問題点はあるが，20mmを超える病巣においても分割切除による適応拡大はある程度許容されるものと考えられた．

　We investigated two hundreds and five mucosal cancers of the stomach which were resected with 2-channeled scope, and followed up. The lesions were divided into two groups ; The lesions of group A were less than 20 mm in size, and the lesions of group B were more than 21 mm in size. The results were as follows :

　1) The mean number of resections in group B was greater than that in group A.

　2) The rate of complete resection significantly decreased in group B.

　3) The rate of complication (hemorrhage) significantly increased in group B. However, endoscopic hemostasis was successful in all cases. Perforation was not experienced.

　4) The rate of cancer residue of group A was 2.3%, and that of group B was 6.5%. There was no significant difference between group A and group B.

　In conclusion, on the condition of careful diagnosis of intramucosal extent of infiltration, adequate marking, complete resection of lesion and all marks, and careful follow-up, it is possible to extend the indication for EMR with 2-channeled scope according to the size of the tumor.