Helicobacter pylori除菌により診断が容易となった早期胃癌の1例

Early Gastric Cancer that Became Distinct after Helicobacter pylori Eradication, Report of a Case

要旨　患者は60歳代，男性．2004年12月に早期胃癌3病変に対してESDを施行し，治癒切除であった．以降年1回の内視鏡検査にて経過観察し，2008年12月にH. pylori除菌療法を施行した．2009年7月に除菌成功を確認したが，胃体上部後壁大彎寄りに中心瘢痕を伴う発赤調の陥凹性病変を認め，生検結果は低異型度の高分化管状腺癌であった．ESDを施行し，24mm，SM1，UL（＋），ly（－），v（－），HM0，VM0であった．除菌前の内視鏡写真では血管透見の不明瞭化と発赤粘膜を認めるのみで，病変の指摘は困難であった．除菌後は背景胃粘膜の発赤が改善しており，病変の診断を容易にしたと考えられた．

　The patient was a male in his sixties. He underwent ESD（endoscopic submucosal dissection）for three early gastric cancers in 2004 and curative resection was achieved. Thereafter he was followed up by annual esophagogastroduodenoscopy and received H. pylori eradication in December, 2008. Successful eradication was proved after seven months, but reddish depressed lesion with central scar was seen on the posterior wall of the upper gastric body. A biopsy specimen revealed well differentiated adenocarcinoma, low grade atypia. He underwent ESD for this lesion and the resected specimen indicated minute submucosal cancer with ulceration, 24mm in diameter.

　Reddish mucosa with indistinct vascular pattern was retrospectively reviewed, but it was difficult to locate this lesion before eradication. Improvement of redness in background gastric mucosa by successful eradication enabled the detection of this lesion.