胃腺腫に対する治療方針—私はこう思う；積極的に治療する立場から

Treatment Strategy for Gastric Adenoma: From the Point of View of Active Treatment

要旨　生検で胃腺腫と診断された病変に対する内視鏡的治療の適用に関しては，明確なガイドラインは存在しない．生検で胃腺腫と診断された症例の中で内視鏡的切除が施行され，切除標本の評価で癌および腺腫と診断された症例について検討を行った．2004年4月〜2014年3月までの間に，内視鏡生検で胃腺腫と診断され，内視鏡治療を施行した124例を対象とした．内視鏡切除標本で胃癌と診断された症例は124例中64例（52％）であった．また，腫瘍長径が20mm以上，発赤調の病変は切除標本で癌と診断される割合が高かった．粘膜下層浸潤や脈管侵襲を伴う症例が存在することからも，生検で胃腺腫と診断されても内視鏡所見，患者背景を考慮して積極的に内視鏡的切除を行ってもよいと考える．

　Guidelines for the adaptation of endoscopic treatment for lesions of gastric adenoma diagnosed by analysis of biopsy specimens are not available. During the period from April 2004 to March 2014, 124 patients were diagnosed with gastric adenoma（Group 3）by analysis of biopsy specimens and were treated at our hospital using ESD（endoscopic submucosal dissection）or EMR（endoscopic mucosal resection）. In total, 64 lesions（52％）were diagnosed as gastric cancer by histological examination of the resected specimens. Based on the analysis of the 124 cases, lesions larger than 20mm in diameter or reddish lesions comprised the statistically significant risk factors for carcinoma. Many cases were diagnosed as gastric cancer by histological examination of resected specimens, although they had been diagnosed as gastric adenoma by analysis of biopsy specimens. We should consider endoscopic resection considering endoscopic findings, the patient background.