外来内視鏡治療の適応判定と治療法選択

Determination of indication and selection of treatment option in endoscopic day surgeries

要旨

この稿では，大腸腫瘍に対する外来内視鏡治療の変遷と治療選択基準について解説する。内視鏡治療は入院不要で幅広い病変に対応できるようになってきた。ESD適応病変やリスクの高い病変は入院治療が一般的だが，合併症は頻度が下がり安全性が向上している。通電を用いた内視鏡的切除や通電を行わないcold snare polypectomy（CSP）やcold forceps polypectomy（CFP）などの安全な処置法がある。10mm以上20mm未満のポリープには適切な治療法が確立されていないが，underwater EMR（UEMR）やgel immersion EMR，bipolar hot snare polypectomy（bipolar HSP）などが試みられている。拡大内視鏡を使用した診断が重要であり，JNET診断およびpit pattern診断が用いられる。小さな病変にも癌の可能性があり，拡大内視鏡診断が必要である。一括で切除することは特に重要であり，適切な治療法選択が求められる。

Endoscopic therapy has evolved significantly, allowing for outpatient treatment of various gastrointestinal lesions, including colorectal tumors. The selection criteria for outpatient endoscopic therapy and the evolution of treatment options for colorectal neoplasms are discussed. While some lesions still require inpatient treatment, advancements in techniques and established guidelines have made it possible to perform many endoscopic procedures on an outpatient basis. The risks of complications, such as delayed perforation and post-procedural bleeding, have significantly decreased over the years. Cold snare polypectomy (CSP) and cold forceps polypectomy (CFP) are safe and effective methods for the removal of small lesions. For lesions ranging from 10 mm to under 20 mm, treatment options are still being explored, including techniques like underwater EMR (UEMR), gel immersion EMR and bipolar hot snare polypectomy (bipolar HSP). Accurate diagnosis through magnifying endoscopy using JNET classification and pit pattern analysis is crucial in guiding treatment decisions. It is important to note that even small lesions can have malignant potential, highlighting the significance of thorough diagnostic evaluation. The principle of en-bloc resection should be considered whenever possible to ensure complete removal. In conclusion, outpatient endoscopic therapy offers safe and effective treatment options for colorectal lesions, with careful consideration of appropriate techniques based on lesion characteristics.