除菌後発見胃癌の内視鏡診断—狭帯域光拡大観察の見地から：微小血管構築像に焦点を当てて

Magnifying Endoscopic Diagnosis of Early Gastric Cancer after Helicobacter pylori Eradication through Microvascular Architecture Imaging

要旨●H. pylori除菌後発見胃癌において拡大内視鏡での微小血管構築像（MVP）の有用性について検討した．2013年4月〜2020年6月まで当院でESDにて切除した405例のうち，除菌後発見胃癌213例245病変を対象とした．除菌後発見胃癌には80.1%（193/241病変）にirregular MVPを認め，MVPは診断のよい指標となった．さらに，17.0%（41/241病変）はregular MSPであったためMSPでの質的診断は難しかったが，それらの病変でも90.2%（37/41病変）はirregular MVPを呈した．範囲診断の正診率においてもMVPを観察することで18.9%の上乗せ効果があった．以上よりMVP診断は除菌後発見胃癌の質的診断，範囲診断いずれに対しても重要であると考えられた．しかしながら，MVP診断は最大倍率で観察する必要があり，日ごろからのトレーニングが必要である．

　We investigated the value of MVPs（microvascular patterns）on magnification endoscopy in gastric cancer after Helicobacter pylori eradication. Among 405 cases resected by endoscopic submucosal dissection from April 2013 to June 2020, 213 cases with 245 lesions of post-eradication gastric cancer were included in the study. Irregular MVPs were found in 80% of post-eradication gastric cancer, suggesting that MVP is a good diagnostic indicator. Additionally, 17%（41 lesions）had regular MSPs, making qualitative diagnosis based on MSPs difficult ; however, 90%（37/41 lesions）of these lesions also had irregular MVPs. Observation of MVPs also had an additional effect of 18.9% on the positive diagnosis rate for range diagnosis. MVP diagnosis is important for the qualitative and lateral extent diagnosis of gastric cancer after eradication. However, the diagnosis of MVP requires observation at maximum magnification, which entails daily training.