通常・色素内視鏡による早期胃癌深達度診断―大きさ・肉眼型別検討を中心に

Diagnosis of the Depth of Early Gastric Cancer by Conventional and Dying Endoscopy: from the View Point of the Size and Macroscopic Type

要旨　当院でESD，手術が行われた早期胃癌304例に対して，通常色素内視鏡による深達度診断を肉眼型別に大きさを中心に検討した．肉眼型ごとに深達度別の病変の大きさをみると，ESDを施行した0-IIc型病変でSM2癌がM～SM1癌より有意に大きく，ESD症例に手術症例も含めた0-IIc型，UL（－）でSM2癌が有意に大きかった（p＜0.05）．UL（－），0-IIc型病変では深達度を推測するのに大きさも参考になる可能性がある．絶対適応病変と判断しESDを施行した病変の4.3％に，適応拡大病変とした分化型腺癌の約6～7％に，それぞれSM2癌を認めた．ESD適応，適応拡大病変か否かを判断する際に注目するのは大きさ，肉眼型が基本であるが，それに加えてSM2癌に特徴的な所見にも注目した観察が必要である．

　We investigated 304 early gastric cancers that underwent ESD（endoscopic submucosal dissection）or operation at our hospital from the viewpoint of the macroscopic type, the size and depth of cancer using conventional and dying endoscopy and resected specimens. Among 166 early gastric cancers treated by ESD, the size of the lesion is significantly larger in SM2 invaded cancers than in M-SM1 invaded cancers in type 0-IIc group. Among all the early gastric cancers regardless of treatment procedure, the size of the lesion is significantly larger in SM2 invaded cancers than in M-SM1 invaded cancers in the type 0-IIc UL（－）group. The size of the lesion may be one of the factors to distinguish M-SM1 from SM2 in type 0-IIc UL（－）gastric cancer. SM2 invaded cancers existed 4.3％ of cases with conventional indication for ESD, and 6～7％ in differentiated-type cancers of extended indication for ESD. The characteristic endoscopic findings of SM2 invaded cancer are important as well as the size and the macroscopic type for correct diagnosis.