胃腺腫に対する治療方針—私はこう思う；経過観察する立場から

Endoscopic Surveillance for Clinical Management of Gastric Adenoma

要旨　3年以上経過観察され，かつ3回以上の生検で胃腺腫と診断された185症例206病変を対象に，その臨床病理学的所見および経過から胃腺腫に対する臨床的対応に関して検討した．中央値5.8年の観察期間内において，73病変（35％）に癌化を認めた．癌化群では初回内視鏡検査時に腫瘍長径11mm以上，陥凹あり，発赤調，経過中に増大や形態変化を認めた病変の割合が非癌化群と比べて有意に高く，癌化の危険因子であった．癌化群73病変のうち63病変に対してESDが施行され，全例が粘膜内にとどまる分化型癌であり，治癒切除が得られた．癌化の危険因子を有さない胃腺腫に対しては経過観察を基本とし，生検で癌が証明された時点での内視鏡治療で対応可能と考えられた．

　Should Gastric Adenoma Be Managed using Endoscopic Surveillance or Endoscopic Resection? The Controversy Persists.

　We retrospectively analyzed serial changes in the endoscopic and histologic findings of 206 tumors in 186 patients that were followed for>3 years and were diagnosed as a gastric adenoma≧3 times by examining a specimen from endoscopic forceps biopsy. Among the 206 gastric adenomas, 73（35％）progressed to adenocarcinomas during the 5.8 years of follow-up（median duration）. Tumor characteristics that were risk factors of adenocarcinoma development, according to Kaplan-Meier analysis, included a large size（≧11mm）, reddish color, the presence of a depressed component at the first endoscopic examination, and an enlargement or a morphological change during follow-up. Of the 73 tumors, 63 were treated with ESD（endoscopic submucosal dissection）. All the resected lesions were intramucosal differentiated-type adenocarcinomas and were cured by ESD.

　We recommend endoscopic surveillance for gastric adenomas without risk factors of adenocarcinoma. The disease can be cured by ESD when a forceps biopsy reveals adenocarcinoma.