胃と腸44巻7号

2009年06月発行

今月の主題 食道胃接合部腺癌の診断 主題

新たな定義に基づいた食道胃接合部の診断―臨床診断─内視鏡の立場から

著者： 天野祐二¹ 石村典久² 越野健司¹ 高橋芳子¹ 三島優子² 結城崇史² 森山修行³ 石原俊治² 木下芳一²

所属機関： ¹島根大学医学部附属病院光学医療診療部 ²島根大学医学部附属病院内科学講座第二 ³島根大学医学部附属病院卒後臨床研修センター

ページ範囲：P.1065 - P.1074

要旨　本邦および欧米の間には，食道胃接合部の内視鏡診断において診断基準の乖離が認められ，その結果，少なからず臨床の場に混乱がみられる．欧米では胃の縦走ひだの口側終末部，本邦では主に食道柵状血管の最下端が食道胃接合部のlandmarkとして用いられてきた．胃の縦走ひだの口側端は術者間での観察空気量の違いにより，大きく位置を変える．一方，食道柵状血管の観察に当たっては，比較的条件を一定に揃えることが可能であるものの，LSBEでの観察率は低く，また逆流性食道炎による炎症の強い粘膜，異型性病変が存在する粘膜では観察できない．今後，食道胃接合部領域の癌が増加する傾向にあることは，本邦の実情により即した食道胃接合部の診断基準を早期に確立することを必要とするものである．

参考文献

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