食道粘膜癌の内視鏡診断―見つけ出し診断，質的診断，病型分類について

Endoscopic Diagnosis of Esophageal Mucosal Cancer

要旨　食道粘膜癌はどのようにしたら内視鏡検査で発見できるか，食道粘膜癌の鑑別診断と深達度診断，更に食道粘膜癌の新しい病型分類について述べた．食道粘膜癌の発見には，食道内を洗浄して観察し，ヨード染色をhigh risk groupを中心に頻用する．食道粘膜癌と鑑別すべきものに，hyperkeratosis，papilloma，dysplasia，良性びらんなどがある．また，深達度をm₁，m₂，m₃に分け，それぞれの内視鏡所見につき述べた．更に，食道粘膜癌を早期癌として0型とし，0-a，0-b，0-cの3型に分類し，粘膜下層以下に浸潤するものを進行癌として1～4型に分類する新しい病型分類を呈示した．

　In this paper, we described endoscopic techniques to identify a mucosal carcinoma in the esophagus, its differential diagnosis, and the evaluation of its depth of invasion as well as its new classification.

　In order to identify a mucosal carcinoma, the esophagus should be washed to clean off mucus, and iodine staining should be routinely used, especially for high risk patients. A hyperkeratosis, papilloma, dysplasia, and benign erosion should be differentiated from a mucosal carcinoma. We presented endoscopic findings of m₁, m₂, and m₃ lesions, which were classified according to the depth of tumor invasion.

　We newly classified a mucosal carcinoma into an early cancer as type 0, and subclassified it into three subtypes such as 0-a, 0-b, and 0-c. On the other hand, a carcinoma invading to the submucosal layer was defined as an advanced cancer, and classified into types 1 to 4.