食道ESD瘢痕近傍病変に対するESD

Endoscopic Submucosal Dissection of a Postendoscopic Dissection Scar

要旨●ESD後瘢痕近傍の病変は粘膜下層で線維化を伴うことが多く，治療の際には高度の内視鏡的技術が必要とされる．当院では瘢痕近傍病変に対し，2つのストラテジーを用いることで，安全なESDを可能としている．瘢痕上を切開する方法（near cutting strategy）と瘢痕領域を完全に含めて切開する方法（far cutting strategy）である．瘢痕近傍病変のESDでは，切開ラインを慎重に決定することは当然重要だが，加えて適切なストラテジーの選択と剝離操作時のtraction法の併用が，治療成功の鍵であると考える．

　The technical difficulty of ESD（endoscopic submucosal dissection）for a lesion near a post-ESD scar is relatively high. We use two strategies to safely perform ESD for near-scar lesions. When a scar is located on the oral side of the lesion, we include the entire scar area in the resection, which is called “far cutting strategy.” Conversely, when a scar is located outside the oral region, we cut the scar area during circumferential resection, which is called “near cutting strategy.” In addition to selecting an appropriate strategy, identifying the incision depth during ESD and using a traction device are considered the keys to successful ESD treatment.