胃と腸48巻2号

2013年02月発行

今月の主題 大腸ESDの適応と実際 主題研究

大腸癌研究会プロジェクト研究の結果報告―「内視鏡摘除手技の標準化」における「最大20mm以上の大腸腫瘍に対する各種内視鏡切除手技の局所根治・偶発症に関する多施設共同研究（前向きアンケート調査）：20mm超大腸ポリープコホート」

著者： 中島健¹² 斎藤豊¹² 田中信治¹³ 飯石浩康¹ 工藤進英¹ 池松弘朗¹ 五十嵐正広¹ 斉藤裕輔¹ 井上雄志¹ 小林清典¹ 久部隆司¹ 山野泰穂¹ 鶴田修¹ 佐野寧¹ 清水誠治¹ 矢作直久¹ 三谷年史¹ 中村尚志¹ 渡辺聡明¹ 藤井隆広¹ 藤森孝博¹ 岩下明徳¹ 味岡洋一¹ 石川秀樹¹ 松田尚久¹² 杉原健一¹

所属機関： ¹大腸癌研究会プロジェクト研究「内視鏡摘除手技の標準化」会議 ²国立がん研究センター中央病院内視鏡科 ³広島大学内視鏡診療科

ページ範囲：P.197 - P.204

要旨　スネアによる従来の内視鏡摘除法（conventional endoscopic resection ; CER）は，径20mm以上の大腸腫瘍一括切除には限界がある．一方，先進施設ではESD（endoscopic submucosal dissection）も導入してきた．本報告は，大腸癌研究会のプロジェクト研究（前向きコホート研究）の結果の一部であるが，径20mm以上の大腸腫瘍内視鏡治療に関して，全国18施設で1,845病変が登録された（CERは1,029病変，ESDは816病変）．CER群，ESD群の一括切除率は，それぞれ56.9％，94.5％（p＜0.01），平均治療時間は，18±23分，96±69分（p＜0.001）であった．穿孔率と後出血率は，それぞれ0.8％，1.6％および2.0％，2.2％で，いずれも低値であった．径40mm以上のCER一括切除率は12.3％と低いが，ESDは93％と高かった（p＜0.01）．ESDは普及しつつあるが，径40mm以上の病変の治療時間は長く（129±83分），先進施設・熟練医での実施が望ましい．

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