全周切除後の狭窄予防法

Prophylactic Treatment against Esophageal Stricture after Endoscopic Submucosal Dissection for Whole Circumferential Superficial Esophageal Squamous Cell Carcinoma

要旨●内視鏡治療技術の進歩により広範囲な食道表在癌に対して内視鏡粘膜下層剝離術（ESD）が選択されるようになってきている．広範囲な食道表在癌ESD後には，食道狭窄を来すことが知られており，ステロイド局注・内服療法を中心とした狭窄予防法が確立してきている．それに伴い，全周性食道表在癌に対してもESDが選択されるようになり，各施設より全周性食道表在癌に対する狭窄予防法の工夫について報告されている．しかし，依然ESD後の狭窄割合は高く，難治性狭窄となりやすい．したがって，確立された狭窄予防法がないのが現状である．また，ESD後に非治癒となり追加治療を検討する必要がある場合も多いため，ESDの選択には慎重になる必要がある．

　Advances in endoscopic treatment technology have made it possible to select ESD（endoscopic submucosal dissection）for wide-spreading superficial ESCC（esophageal squamous cell carcinoma）. Moreover, esophageal stricture occurs after ESD for widespread superficial ESCC, and prophylactic treatment against esophageal stricture centered on local steroid injection and oral steroid administration has been established. Along with this, ESD has been selected for whole circumferential ESCC, and each institution has reported on devising a prophylactic treatment against esophageal stricture. However, the rate of post-ESD stricture is still high, refractory stricture is likely to occur, and there is no established prophylactic treatment presently. In some cases, it becomes noncurative resection after ESD for the whole circumferential ESCC, needing additional treatment. Therefore, it is necessary to carefully select ESD for whole circumferential ESCC.