手つなぎ・横這い型癌の新展開—手つなぎ・横這い型胃癌の内視鏡診断

New Developments in “Crawling-type” Adenocarcinoma of the Stomach:Endoscopic Diagnosis of “Crawling-type” Adenocarcinoma of the Stomach

要旨●2018年4月〜2020年12月までの間に，当院で内視鏡的粘膜下層剝離術（ESD）もしくは外科手術をされ，切除検体で手つなぎ・横這い型胃癌と診断されかつ，術前にNBI併用拡大内視鏡観察（以下，NBI拡大観察）を施行されている早期胃癌35例36病変を対象とした．既報と当院での症例に対して内視鏡的特徴を明らかにすべく検討を行った．多くの症例で色調変化や隆起・陥凹性変化に乏しく，胃小区の乱れとしてしか認識できないものが多く，NBI拡大観察でも多彩な表面構造の不整を呈するため特異的な所見というものがなく，わずかな表面構造の形状不均一に注目して診断する必要がある．一部の症例においてirregular micro pitを認めており，手つなぎ・横這い型胃癌に特徴的なNBI拡大所見である可能性が示唆されたが，少数例であり，今後の検討が必要と思われる．

　Thirty-five patients with early-stage gastric cancer who underwent endoscopic submucosal dissection or surgery at our hospital between April 2018 and December 2020 for the presence of “crawling-type” adenocarcinoma of the stomach were enrolled in this study. The patients subsequently underwent preoperative NBI（narrow-band imaging）magnification endoscopy. The endoscopic characteristics of the lesions were investigated and compared with those previously reported.

　In many cases, the lesions lacked color change, elevation, or depression and could only be recognized as disordered gastric subdivisions. On NBI magnification endoscopy, the lesions showed various surface irregularities, and no specific findings were obtained. Irregular micropits were observed in some cases, suggesting that this may be a characteristic finding of “crawling-type” adenocarcinoma of the stomach on NBI magnification endoscopy.