胃と腸55巻13号

2020年12月発行

今月の主題 大腸鋸歯状病変の新展開 主題

大腸鋸歯状病変に対する臨床診断の現状と課題—積極的治療の観点から

著者： 岸田圭弘¹ 堀田欣一¹ 今井健一郎¹ 伊藤紗代¹ 小野裕之¹

所属機関： ¹静岡県立静岡がんセンター内視鏡科

ページ範囲：P.1579 - P.1587

要旨●鋸歯状病変はHP，SSL，TSAに大別され，これらの癌化率は異なる．そのためこれらを鑑別し，さらにdysplasiaや癌の有無を診断したうえで，病変に応じた切除対象と切除方法の選択をする必要がある．今回，筆者らは当院で切除された10mm以上のHPとSSLおよびそれらにdysplasiaや癌を伴った病変を対象とし，診断に有用な所見を検討した．病変サイズが大きいほどSSLの割合が増加し，またdysplasiaや癌を有する割合も増加した．HPとSSLの鑑別については，両者の鑑別に有用と言える内視鏡所見はなかった．dysplasiaや癌の有無については，病変サイズ，二段隆起，腫瘍性JNET（Type 2A, 2B, 3）が有意に関連し，特に15mm以上で二段隆起もしくは腫瘍性JNETのいずれかを認める場合は診断率が高く，有用と考えられた．

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