1)上部消化管 (1)ポリープ

Endoscopic Polypectomy for Gastric Polyps

要旨　胃のポリープを中心にポリペクトミーの適応，手技，偶発症について述べた．ポリペクトミーの適応は，①貧血の原因，②局在癌の可能性，③精神的ストレスとなり不定愁訴の原因，④幽門輪への嵌頓による通過障害，などである．出血性素因がある場合には禁忌となる．高周波電源装置，高周波スネアは，病変の性状に応じてモードの選択や使用する器具を選択する必要がある．また，偶発症（出血，穿孔）の発生に十分に注意しなければならない．胃のポリペクトミーは消化管腫瘍に対する内視鏡的切除の最も基本となる手技である．EMRの初心者向けの治療と思われがちであるが，十分なインフォームド・コンセントのもとに処置具や基本手技を熟知して臨むことが肝要と考える．

　We describe the indications and techniques for, and complications of polypectomy, mainly in patients with gastric polyps. The indications for polypectomy include 1) anemia, 2) the possibility of localized cancer, 3) unidentified clinical syndromes due to mental stress, and 4) passage disorders caused by incarceration of the pyloric sphincter. Polypectomy is contraindicated in patients at high risk for bleeding. As for high-frequency generators and high-frequency snares, the operation mode and devices used should be compatible with the characteristics of the lesion being treated. Care should be exercised to avoid complications associated with polypectomy, such as bleeding and perforation. Gastric polypectomy is the most basic procedure for endoscopic resection of gastrointestinal tumors. This procedure is generally considered suitable for endoscopists with limited experience in endoscopic mucosal resection. However, treatment devices should be carefully selected and the basic technique mastered. It is also essential to obtain fully informed consent from patients.