胃と腸56巻1号

2021年01月発行

今月の主題 早期胃癌内視鏡治療・適応のUPDATE 主題

早期胃癌EMR/ESDの絶対適応病変を決定するための術前内視鏡診断と問題点—組織型と大きさ

著者： 金坂卓¹ 上堂文也¹ 道田知樹¹ 石原立¹

所属機関： ¹大阪国際がんセンター消化管内科

ページ範囲：P.9 - P.16

要旨●早期胃癌の通常内視鏡観察では，分化型癌は発赤調，未分化型癌は褪色調を呈することが多く，隆起型（0-I/0-IIa）の早期胃癌のほとんどは分化型である．拡大内視鏡観察では，表面微細構造が視認される場合は分化型癌と考える．一方，視認されない場合は微小血管構築像を評価し，開放性ループであれば未分化型癌，そのほかは分化型癌と考える．内視鏡検査による腫瘍径の評価方法には，スコープ径や生検鉗子の開口径との比較，あるいはメジャー鉗子を用いる方法がある．ただし，現時点では，内視鏡治療前は生検病理組織学的診断による組織型の確認，治療後は切除標本による組織型と腫瘍径の確認が必要である．

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