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—深達度診断—EUS

著者： 辻井芳樹¹ 林義人¹ 加藤元彦² 井上拓也³ 吉井俊輔¹ 坂谷彰彦¹ 井上貴功¹ 上間遼太郎¹ 加藤穣¹ 齊木浩二¹ 中川健太郎¹ 木村瑛司¹ 新﨑信一郎¹ 飯島英樹¹ 竹原徹郎¹

所属機関： ¹大阪大学大学院医学系研究科消化器内科学 ²慶應義塾大学医学部消化器内科 ³大阪急性期・総合医療センター消化器内科

ページ範囲：P.31 - P.40

文献概要

要旨●早期胃癌の深達度診断においてEUSは有用であるが，通常内視鏡検査（CE）に対する上乗せ効果に関しては不明な点も多い．治療前精査症例を対象にした筆者らの検討では，簡便な診断基準に則ったCEの正診率は，EUSと有意差なく粘膜癌では90%を超えていたものの，深部浸潤癌では65%と低かった．一方，EUSはCEで深読みした粘膜癌の約6割を正診していた．そこで，CEで深部浸潤を疑った症例に対してのみEUS診断を適用しCEとEUSを組み合わせると，CE単独・EUS単独での診断に比して有意に正診率が向上したことから，粘膜癌はCEで診断し，深部浸潤を疑う病変に対してのみEUSを行う方法が効率的で正確な診断を可能にすることが示唆された．EUSの付加価値は限定的であると考えられ，特性を理解し役割を明確にしながら診断に用いる必要がある．

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