LSBEに発生した食道腺癌に対するstepwise ESDの有用性

Topics Related to Esophageal Adenocarcinoma:Utility of Stepwise ESD for Esophageal Adenocarcinoma Occurring from LSBE

要旨●LSBEに発生するBarrett腺癌では，低異型度高分化腺癌がLSBE全体に拡がっている場合がある．このような癌の場合，壁深達度も粘膜内癌の場合が多く内視鏡治療で根治可能である．同病変のESD一括切除においては，LSBE全体を切除する必要があるため，広範な全周性切除となり，術後に高度の食道狭窄が必発である．そこで，最初に広範な亜全周性切除およびトリアムシノロン局注による狭窄予防を行う．約2〜3か月後の切除後潰瘍が上皮化（扁平上皮化）した時点で残ったLSBEをESDで切除する．計画的かつ多期的なESDによる分割切除（stepwise ESD）を行うことで，高度狭窄が回避可能となる．当院ではLSBEほぼ全体に拡がるBarrett腺癌の3例にstepwise ESDを施行し，高度狭窄なしに完遂している．stepwise ESDは広範囲の食道全周性切除に有用な治療法と考える．ただし経験数は少なく，さらなる検討が必要である．

　Some Barrett's adenocarcinoma arising in the LSBE（long-segment Barrett's esophagus）accompany with low grade dysplasia spreading throughout the LSBE. Such cases are often intramucosal carcinoma, which can be cured radically by endoscopic treatment. However, when such lesions are resected en bloc with ESD（endoscopic submucosal dissection）, severe postoperative esophageal stricture are inevitable. Therefore, the first step is sub-circumferential resection, followed by local injection of triamcinolone to prevent stenosis. As a 2nd step, the remaining LSBE is excised by ESD when the resected ulcer healed after 2-3 months. Severe stenosis can be avoided by performing a planned and multistage stepwise ESD. We have performed stepwise ESD in three cases of Barrett's adenocarcinoma spreading throughout the LSBE, and the procedure was completed without severe postoperative stenosis. Stepwise ESD is considered as a useful treatment for circumferential Barrett's lesions. However, as the number of the cases is small, further study is required.