食道胃接合部腺癌の深達度診断—内視鏡の立場から

Diagnosis of Invasion Depth of Early Esophagogastric Junction Adenocarcinoma

要旨●通常内視鏡検査における食道胃接合部腺癌の深達度診断は，治療方針の決定における重要な因子である．食道胃接合部から胃側2cm以内に存在する接合部胃癌の深達度診断には色調変化，混合型の形態，SMT様隆起が重要である．筆者らの検討では，正色調/褪色調病変の96%はM〜SM1癌である一方，混合型を呈する病変の60%はSM2癌で，SMT様隆起を呈する病変の86%はSM2癌であった．食道胃接合部から食道側2cm以内に存在する接合部食道腺癌の深達度診断には，表在隆起型（0-I）の形態やSMT様隆起が重要である．表面型（0-II）の94%がM〜SM1癌である一方，SMT様隆起を呈する病変の67%はSM2癌であった．

　Cancer invasion depth of EGJ（esophagogastric junction）adenocarcinoma is an important factor in determining the treatment strategy. Color change, mixed-type morphology, and SMT-like marginal elevation are important for diagnosing the depth of invasion of gastric cancer located within 2cm below the EGJ. In our study, approximately 96% of the isochromatic/pale lesions were M-SM1 cancers, 60% of the mixed-type lesions were SM2 cancers, and 86% of the lesions with SMT-like marginal elevation were SM2 cancers. On the other hand, protruded-type morphology（0-I）and SMT-like marginal elevation are important for diagnosing the depth of invasion of esophageal cancer located within 2cm above the EGJ. Approximately 94% of the lesions with superficial-type morphology（0-II）were M-SM1 cancers, while 67% of the lesions with SMT-like marginal elevation were SM2 cancers.