26か月間で6個の早期胃癌を内視鏡的粘膜切除術により切除した1例

A 72-year-old Male with6Early Gastric Cancers Resected by Endoscopic Mucosal Resection Over a Period of26Months, Report of a Case

要旨　患者は72歳，男性．胃癌検診で異常を指摘され当科を受診した．上部消化管内視鏡検査で，胃前庭部前壁に直径2cmの0´ IIaおよび胃角部後壁に0.7cmの0´ IIcを認め内視鏡的粘膜切除術（EMR）を行った．病理組織診断は高分化型管状腺癌（tub1），深達度mであった．この後，初回EMR後17～26か月にかけて3個の0´ IIcと1個の0´ IIaに対してEMRを行った．初回EMR後26か月の時点でamoxicillin，clarithromycin，lansoprazoleによるHelicobacter pylori除菌療法を行った．1年後の尿素呼気試験でHelicobacter pylori陰性であることを確認した．その後は初回EMR後83か月まで局所遺残および新たな胃癌は認めていない．

　A 72-year-old male was admitted to our hospital because a mass screening X-ray examination pointed out an abnormality in his stomach. Gastrointestinal endoscopy revealed a flat elevated lesion on the anterior wall of the antrum and a flat depressed lesion on the posterior wall of the angle. We resected these lesions using endoscopic mucosal resection (EMR). Pathologically, they were intramucosal well differentiated tubular adenocarcinomas. Between 17 months and 26 months following the first EMR, we found three other flat depressed lesions and one other flat elevated lesion and resected them by EMR. Their pathological features were the same as those mentioned above. At 26 months after the first EMR, eradication therapy for Helicobacter pylori, using amoxicillin, clarithromycin and lansoprazole, was performed because of the rapid urease test was positive. We confirmed the negativity of Helicobacter pylori by a breath urea test 12 months after eradication. Finally, we have not found any other gastric cancers more than 57 months after the eradication therapy.