食道亜全周・全周ESD後の狭窄予防―ステロイド局注の立場から

Prevention of Stricture Following Semi-circular or Circular Esophageal ESD

要旨　亜全周以上を占める広範囲な食道表在癌に対するESDは，術後狭窄が問題となる．亜全周切除例および全周切除例におけるtriamcinolone acetonide局注法（ETI）の治療成績を示し，同治療の難渋例について検討を行った．亜全周切除例では，局注群は非局注群と比べ，狭窄出現率，内視鏡的バルーン拡張術（EBD）平均回数の有意な低下を認めた．全周切除例では，両群間でいずれも有意差を認めなかった．亜全周切除例の局注群においては，生理的狭窄部を含む局在（Ce，Ut，Ae）のみが狭窄出現の独立規定因子であった．全周切除例および生理的狭窄部を含む亜全周切除例では，ETIのみでは難渋する可能性があり，今後新たな治療法の開発が必要である．

　ESD（endoscopic submucosal dissection）of widespread mucosal resection within the narrow esophageal lumen may cause of stenotic change. The goal of this study was to determine the utility and the limitation of endoscopic triamcinolone injection for the prevention of stricture formation after ESD. In the semi-circular resection cases, the incidence of stricture and the number of times it is required endoscopic balloon dilation procedures, were significantly lower in the injection group than in the non-injection group. However, in the circular cases, there were no significant differences between both groups. In the injection group after semi-circular ESD resection, multivariate logistic regression analysis showed that tumor location within was the only significant and risky factor for stricture formation. Endoscopic triamcinolone injection can effectively prevent esophageal stricture after semi-circular ESD resection. However, it may be less effective than former when the tumor is located within the esophageal natural constriction（cervical or upper thoracic or abdominal lesions）or occupied all-circumferentially. Therefore, the development of new treatment for prevention of esophageal stricture is necessary.