早期食道癌に対する内視鏡的粘膜切除の実際―EMRTとEMRC

Endoscopic Mucosal Resection of Early Esophageal Cancer: EMRT and EMRC Techniques

要旨　食道の上皮内癌および粘膜癌に対する内視鏡的粘膜切除術として，1989年より透明オーバーチューブを用いる方法（EMRT）を実施し，1992年より透明プラスチックキャップを用いる方法（EMRC）を導入した．現在まで9例（EMRT8例，EMRC1例）に施行し，いずれも特記すべき合併症なく病変を切除しえた．最長3年の観察では明らかな再発の兆候を認めていない．1回の切除量は長径約2cm前後であるが，反復切除により半周以上の切除も容易であった．経口摂取は1，2日後より可能であり，形成された潰瘍も約1か月以内に完治した．本法は侵襲も少なく安全性も高いことから，その適応が遵守されれば早期食道癌に対する有効な治療法の1つになりうると共に，ヨード不染部に対する完全生検の手段としても有用であると考えられる．

　As a strategy for treating mucosal cancer of the esophagus, in 1989 we developed a new technique of endoscopic mucosal resection using a transparent overtube, called the EMRT procedure. In 1992, we improved it and made it simplified using a cap-fitted panendoscope, and renamed it the EMRC procedure.

　A transparent tube (EMRT tube, Olympus), a smallsize snare (SD-7P, Olympus), and grasping forceps are essential to perform the EMRT procedure. But for the EMRC procedure, one needs only a transparent cap (EMRC cap, Olympus)and a small-size snare (SD-7P, Olympus).

　These two procedures were applied to nine cases of early esophageal cancer (EMRT to eight cases, EMRC to on ecase) without major complications such as uncontrollable bleeding or perforation. All of the iatrogenie ulcers, including four cases of extensive resection of more than half the esophageal circumferential size, healed within one month without stenosis. No local recurrence of tumor was found during the follow-up period as much as 36 months. The resected specimen was 2 to 3 cm in size and adequate for histopathological diagnosis.

　We conclude that both the EMRT and EMRC proce-dures are safe, minimally invasive and sufficient for histopathological analysis. Because of its safety and simplicity, we recommend the EMRC procedure for a beginner in esophageal mucosectomy. We apply the EMRC procedure to gastric and colonic mucosectomies as well.