食道胃接合部腺癌の内視鏡治療

Endoscopic Therapy for Superficial Adenocarcinoma of the Esophagogastric Junction

要旨●食道胃接合部腺癌の増加や内視鏡治療技術の発展に伴い，食道胃接合部腺癌に対して内視鏡治療を行う機会は増えているが，治療の適応や治癒基準については，明確なコンセンサスが得られていない部分がある．当院では胃癌治療ガイドラインに準じて内視鏡治療適応の判断および治癒判定を行っており，治癒基準を満たした症例の治療成績は良好であった．一方で，これらの中には食道癌診断・治療ガイドラインに準じた場合に，非治癒切除となる症例が含まれている．内視鏡治療は食道胃接合部癌に対しても有用と考えられるが，治療の適応および治癒基準を確立させるためには，より多くの症例を集積し，詳細な検討を行うことが必要である．

　With an increase in the incidence of superficial adenocarcinoma of the esophagogastric junction（EGJAC）and the development of endoscopic therapy, the opportunity to apply endoscopic therapy to EGJAC is increasing in Japan. However, there remain some problems with the indication and curative criteria for endoscopic therapy. We report that the patients who met the curative criteria of the gastric cancer guideline showed a good outcome（5-year survival rate of 97.8%）. On the other hand, non-curative patients with esophageal cancer diagnosis and treatment guideline were included among these curative patients according to the gastric cancer guideline. Although endoscopic therapy may be useful against superficial EGJAC, a multi-center study with more cases and detailed assessments is needed to establish appropriate indication and curative criteria.