食道ESD瘢痕近傍病変に対するAPC治療

APC for Near Scar Lesions after ESD Treatment of Early Esophageal Cancer

要旨●早期食道癌の内視鏡治療は近年，EMRからESDが主流になり，周在性が広く大きな病変の一括切除が可能となったが，瘢痕近傍遺残，局所再発・多発癌の治療は，瘢痕のために切除が難しい場合がある．当院では表層をまず焼灼して粘膜上皮剝離を行い，さらに剝離面を焼灼する粘膜上皮下焼灼法によるAPCを2002年より開始し，過去20年間に248例のさまざまな状況の早期食道癌に適応してきた．このうち，狭窄対策のためのESD遺残やESD後瘢痕近傍病変にAPCを施行した症例は42例あり，最終的に局所制御不良となったのは1例（2.4%）のみであった．病理組織学的評価が十分に得られないものの，手技は簡便で重篤な合併症はなく，外来治療も可能である．APC治療のコツとポイントについて解説する．

　Recently, endoscopic treatment of early esophageal cancer has shifted from endoscopic mucosal resection to ESD（endoscopic submucosal dissection）, which allows en bloc resection of large lesions with wide margins. However, resection of near scar remnants, local recurrence, and multiple cancers may be challenging due to scarring.

　Our department began doing APC（argon plasma coagulation）in 2002 by first cauterizing the topmost layer, followed by mucosal epithelial ablation by peeling, subepithelial cauterization, and cauterizing the ablated surface. We have cared for 248 patients with varied early esophageal cancer situations over the previous 20 years. Of these, 42 cases of APC were conducted for planned remnants of ESD to prevent stenosis or for lesions near the post-ESD scar, and only one case（2.4%）was found to have poor local control. Histopathological examination is insufficient, which is an issue with APC. The treatment is simple to carry out, though, and no significant issues have been reported. In addition, it can be treated in an outpatient setting. The key recommendations for APC treatment will be discussed.