大腸鋸歯状病変に対する臨床診断の現状と課題—経過観察，選択的治療の観点から

Canceration from Hyperplastic Polyps Is Called the Serrated Neoplastic Pathway

要旨●過形成性ポリープからの癌化はserrated neoplastic pathwayと称される．鋸歯状病変の取り扱いについてはさまざまな意見があるが，筆者らの検討では明らかな腫瘍化，特にSSA/Pにおけるcytological dysplasiaの発見には，通常内視鏡検査での二段隆起・結節，発赤の存在，さらには拡大内視鏡検査でのJNET分類，pit pattern分類を用いた腫瘍所見の存在が有用であり，これらの所見は大腸鋸歯状病変の治療適応の判断に大きく寄与すると思われる．また，超拡大内視鏡やAIなど新たな内視鏡診断ツールの拡充に期待する．

　Serrated neoplasia pathway is the canceration from hyperplastic polyps. There are various opinions about the treatment of serrated lesions, but the presence of tumorigenesis, especially cytological dysplasia in SSA/P, which is clear in our study, is usually the presence of two-step ridges/nodules and redness in endoscopy ; furthermore, using J-NET and pit pattern classifications in magnifying endoscopy to identify the existence of tumors is useful, thereby greatly contributing to the treatment indication for serrated lesions of the colon. We also anticipate the endoscopic diagnosis tools, such as ultramagnifying endoscopes and AI.