長期経過例からみたstrip biopsyの問題点と対策（特に同時・異時性多発病変の検討）

Strip Biopsy: Its Problems and Measures Implied by a Long-term Follow-up Study (Simultaneous and Metachronous Multiple Cancers)

要旨　現在までに321症例の早期胃癌に対して根治目的に内視鏡的治療を行い，経過観察を行ってきた．そのうち，40例（12.5％）に多発胃癌症例を経験している．多発胃癌症例は高齢者の男性に多く，主病変は隆起型，A領域に発生するものが多く認められた．また，副病変のほとんど（45病変中44病変）は分化型胃癌であった．内視鏡治療における単発胃癌症例と多発胃癌症例の5年生存率は96.0％，93.8％であり，両者の生存率に差はなかった．更に，経過観察中に8例において，新たな早期胃癌9病変が発見された．すべて内視鏡的治療の適応範囲内の分化型胃癌であり，8例中7例には内視鏡的治療が施行され，良好な経過を認めている．以上の成績から，内視鏡的治療適応内の病変が多発している症例では，各々の病変を内視鏡的治療することによって根治効果が得られることが明らかになった．更に，術後の経過観察中に発見される多発早期胃癌病巣は，1年に1度の内視鏡観察により，内視鏡的治療の適応内の病変で診断され，追加の内視鏡的治療で根治できた．

　Three hundred twenty one gastric cancers were treated endoscopically and have been followed. There were forty cases of multiple cancer; 35 cases of double cancer and 5 cases of triple cancer. Multiple cancer was more common in males than in females. Most of the main lesion of multiple cancer was elevated type and was located in the area A. Almost all concurrent lesions (44 out of 45 lesions) were well differentiated type and many of them were elevated type. No patient died of gastric cancer during the follow-up period. The survival rates of multiple cancer and solitary cancer were not significantly different. In 8 patients with multiple cancer, 9 lesions were detected during the follow-up period. All of them were well differentiated type and had indication for endoscopic treatment. Seven out of 8 patients were treated endoscopically and no relapse has been noted.

　Endoscopic therapy can be applied to a multiple gastric cancer as a curative procedure, as long as individual lesions have indication for endoscopic treatment. Our study demonstrates that a metachronous multiple cancer can be detected by annual endoscopic examinations and can be completely cured by endoscopic resection.