早期食道癌に対する内視鏡的粘膜切除術―EEMR-tube法の実際

Endoscopic Mucosal Resection for Early Esophageal Cancer by the EEMR-tube Method

要旨　食道の早期表在癌の増加と共にその治療方針が見直されるようになり，内視鏡的粘膜切除術が行われるようになってきた．その適応は，①ep～mm₂の粘膜癌で，②mmの範囲が2cmぐらいまで，③全周性でなく，④病巣数3～4個まで，となる．内視鏡的粘膜切除用のEEMR-tubeを開発し，簡単かつ容易に，大きな粘膜切片（最大5cm）が安全に切除できるようになった．その手技の詳細と注意点につき述べた．粘膜切除を施行した81症例103病巣につき検討し，その成績，合併症などにつき述べた．以前は困難であった食道癌に対する内視鏡的粘膜切除術も，対象症例の発見，適応の決定，十分な大きさの粘膜切片の切除などすべての面で，胃や結腸を凌ぐものとなったと思っている．

　The incidence of early and superficial carcinomas of the esophagus have markedly increased. The strategy for treatment of early esophageal cancer has been changed and the endoscopic mucosal resection has been performed over the last several years.

　The indications for endoscopic mucosal resection are as follows: a lesion within the proper mucosal layer invasion; a lesion whose invading part to the proper muscle layer is less than 2 cm in size; a lesion which is not extended to the whole esophageal circumference size; less than four lesions in a case.

　We showed details of the technique of endoscopic mucosal resection using an EEMR-tube and also described the results of 81 cases treated by this method. The endoscopic mucosal resection of the esophagus can be applied more extensively than those of the stomach and the colon.