Barrett食道腺癌のsurveillance—SSBEを中心に

The Surveillance of Superficial Barrett's Esophageal Adenocarcinoma in Short-segment Barrett's Esophagus

要旨●Barrett食道腺癌（BAC）の発生率は，H. pylori感染率の低下やGERD罹患率の上昇により，徐々に増加傾向である．本邦ではSSBEが多いが，LSBEと比べSSBEからの発癌率は低く，その存在のみでBACの高リスク因子とは言えない．本稿では，当院でのSSBE由来表在型BACの発見契機を検討し，癌の発見時にGERD症状や逆流性食道炎が必ずしも存在しないこと，SSBEに漫然と逆流性食道炎が存在すると，癌の発見が遅れる危険性があることがわかった．サーベイランスを考えるうえで，炎症を伴うSSBEは，炎症を伴わないSSBEよりも内視鏡検査の間隔を短くすることが望ましい．

　The prevalence of BAC（Barrett's esophageal adenocarcinoma）has gradually increased due to a decrease in the prevalence of H. pylori infection and an increase in the prevalence of GERD. Although SSBE is common in Japan, the carcinogenic rate from SSBE is lower than that of LSBE, and its presence alone cannot be said to be a high-risk factor for BAC. In this paper, we examine the triggers for the discovery of SSBE-derived superficial BAC at our hospital. As it turns out, neither the presence of GERD nor of reflux esophagitis is necessary at the time of the discovery of BAC, and there is a risk of delaying the detection of cancer because of SSBE with either repeated or protracted reflux esophagitis. In terms of surveillance, it is desirable that SSBE with inflammation have shorter endoscopy intervals than SSBE without inflammation.