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要旨●背景:胃上皮下腫瘍(SET)の診断について拡大内視鏡を含めた内視鏡所見を系統的に検討した報告は少ない.本研究の目的は,特に病変の局在が粘膜層にある胃SETの形態と壁内の局在との関連性を求めることであった.対象と方法:2013年1月〜2022年11月の期間に,福岡大学筑紫病院で上部消化管内視鏡検査を施行され,内視鏡的または外科的切除された,粘膜層,および粘膜層から粘膜下層に病変の中心がある胃SETについて,後ろ向きに内視鏡所見および病理組織学的所見を評価した.本研究の主要評価項目は,胃SETに認められる通常・NBI併用拡大内視鏡(M-NBI)所見と病理組織学的所見との関連性を求めることであった.結果:本研究の解析対象となった病変は24病変で,その内訳は,胃NET G1 10病変,胃底腺型腺癌12病変,胃リンパ球浸潤癌2病変であった.通常内視鏡で観察された病変の立ち上がりについて,急峻な立ち上がりを呈する病変(p<0.001)と病変表面の陥凹を呈する病変(p=0.006)は病変の垂直方向の病変径が有意に大きかった.M-NBIで観察された窩間部の開大(p=0.018),absent MS pattern(p=0.002),開放性のMV pattern(p=0.009)を呈する病変は,表層上皮と病変頂部との距離が有意に短かった.結論:病変の局在が粘膜固有層(または粘膜固有層および粘膜下層)に存在する胃SETについて,内視鏡所見と病理組織学的所見の間に関連性があることが示唆された.ごく少数例を対象とした後ろ向き研究であり,さらに症例を蓄積したうえで,検証が必要である.
Objective:Given the few reports on the diagnosis of gastric SETs(subepithelial tumors)based on a systematic review of endoscopic findings, including those obtained by magnifying endoscopy, this study aimed to determine the relationship between the morphology and intramural localization of gastric SETs, particularly in lesions localized in the mucosal layer.
Method:Endoscopic and histopathologic findings of gastric SETs were retrospectively evaluated with localization in the mucosal lamina propria(or in the mucosal lamina propria and submucosa), which were endoscopically or surgically resected at Fukuoka University Chikushi Hospital between January 2013 and November 2022. The primary end-point of this study was to determine the association between the conventional and M-NBI(magnifying endoscopy with narrow-band imaging)and histopathological findings in gastric SETs.
Results:Twenty-four lesions were analyzed in this study:10 neuroendocrine tumor G1, 12 gastric adenocarcinomas of fundic gland type, and 2 gastric carcinomas with lymphoid stroma. With the increasing number of lesions detected by conventional endoscopy, a steep increase(p<0.001)and decrease of the lesion surface(p=0.008)were associated with the vertical tumor diameter of the lesion. The open interorbital area(p=0.018), absent microsurface pattern(p=0.002), and opened microvascular pattern(p=0.009)observed by M-NBI were associated with the distance between the superficial epithelium and the apex of the lesion.
Conclusion:Our results suggest a relationship between endoscopic and histopathologic findings in gastric SETs with lesions localized in the mucosal lamina propria(or in the mucosal lamina propria and submucosa). However, this retrospective study consisted of a very small number of cases ; thus, further validation is needed after accumulating more cases.
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