異時多発癌予防にRFA（radiofrequency ablation）が有用であった多発ヨード不染を背景とする食道扁平上皮癌の1例

Esophageal Multiple Metachronous Squamous Cell Carcinomas with Lugol Voiding Lesions in the Background Mucosa Successfully Treated by Radiofrequency Ablation, Report of a Case

要旨●患者は50歳代，男性．高度の多発ヨード不染を背景に発生した食道扁平上皮癌で，異時多発癌を繰り返し，3年6か月の間に3回のESDを要した．さらなる異時多発癌予防のためにRFAを施行する方針とし，台湾にあるE-Da HospitalのWen-Lun Wang先生に紹介し，HALO360で切歯20cm〜SCJ 44cmに対し全周性にRFAを施行した．1か月後，嚥下障害が出現したが，合計4回のEBDと1回のトリアムシノロン局注にて狭窄を解除しえた．RFA後多発ヨード不染食道はヨード正染食道となり，以後，4年間異時多発癌を認めていない．したがって，RFAはまだら不染食道の異時多発癌発生を予防する可能性が示唆された．

　A male patient aged in his 50s was referred to our hospital for the treatment of ESCC（esophageal squamous cell carcinoma）. The patient underwent endoscopic submucosal dissection thrice over 3 years and 6 months due to the development of multiple metachronous SCCs. His background mucosa showed multiple Lugol voiding lesions, which is a well-known indicator of multiple metachronous SCC. RFA（radiofrequency ablation）was planned to prevent the further development of such metachronous ESCCs. Therefore, the patient was referred to Dr. Wen-Lun Wang, E-Da Hospital, Taiwan ; here, RFA was performed using HALO³⁶⁰procedure at 20-44cm from the incisor.

　One month after the RFA, the patient complained of dysphagia. Severe stenosis was observed at 20cm from the incisor ; it was treated by performing EBD（endoscopic balloon dilatation）four times and injecting Triamcinolone once. This resolved the stenosis. And, the Lugol voiding areas have been stained well. No metachronous SCCs have occurred over 4 years since the RFA. Therefore, it is suggested that the RFA might prevent metachronous ESCCs in multiple Lugol voiding esophagus.