内視鏡的粘膜切除法にて治療した早期胃癌の3例

Early Gastric Cancer Treated by Endoscopic Mucosal Resection, Report of Three Cases

要旨　内視鏡的切除にて治療された早期胃癌の3症例を呈示する．病変の部位により，内視鏡操作に難渋することがあるが，当院では2本の内視鏡を部位により選択して用い，また，把持鉗子を大型化することにより，病変を確実に把持し，より大きな材料を得るよう努めている．

　We report here 3 cases of gastric cancer treated by endoscopic mucosal resection (EMR). We used two ordinary endoscopes instead of a special one with two forceps-channels. Depending on the location of a lesion, one of the two types of endoscope is selected, i.e., either side-viewing or forward-viewing one. For a lesion in the gastric body, the side-viewing scope was used for observation, injection and lifting up the mucosa, and a forward-viewing one for cutting. For a lesion in the antrum, two forward-viewing scopes were used. A video-endoscope or endoscopic TV system (OEM TV system) was useful in cooperatively handling these two scopes. The way how to tightly grasp the ballooned mucosa after submucosal saline injection was the key-element for successful EMR. We have manufactured a large grasping forceps which does not cut off the grasped mucosa. And it worked very well. Endoscopic ultrasonography was used in estimating the depth of invasion. However, tiny lesions were occasionally difficult to detect by this method.