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

Current Status and Problems of Clinical Diagnosis for Serrated Lesions of the Large Intestine:from the Viewpoint of Follow-up and Selective Treatment

要旨●当院では以前よりSSA/Pに対して内視鏡検査による詳細観察を行い，悪性化のポテンシャルを有するとされているSSA/P with cytological dysplasia，または内視鏡治療適応内のcancer in SSA/Pまでの段階で診断することを目指し，原則そのような病変のみを治療の対象としている．今回SSA/Pと診断し，経過観察後，治療した55病変を検討したが．内視鏡所見の変化に着目し，切除適応病変を判断することで全例適切に内視鏡治療にて根治切除可能であった．後ろ向きの，かつ限られた条件での検討であったが，SSA/Pの癌化率は高くはないこと，SSA/P with cytological dysplasia，cancer in SSA/Pへの変化は内視鏡所見にて診断可能であることが多く，経時的に経過観察が可能な場合は内視鏡診断にて必要な病変のみ治療する方法も選択肢の一つと考える．

　We have previously indicated treating only lesions that were considered to be high risk based on endoscopic findings for SSA/P. Specifically, we diagnose SSA/P with cytological dysplasia and cancer in SSA/P via observation using a magnifying endoscope, and perform radical endoscopic resection. In this study, we examined 55 lesions that had been previously diagnosed as SSA/P via endoscopic findings, and were treated after follow-up. All patients were successfully resected with endoscopic treatment, by deciding on the indications for resection utilizing the endoscopic findings that we emphasize in our hospital. We consider that the selective treatment policy of our hospital is appropriate as the cancerization rate of SSA/P is not high, and the progression to SSA/P with cytological dysplasia or cancer in SSA/P can be diagnosed via endoscopic findings.