胃と腸58巻2号

2023年02月発行

今月の主題 鋸歯状病変関連の早期大腸癌 主題

癌併存大腸SSLの内視鏡診断—超拡大内視鏡観察の立場から

著者： 小川悠史¹ 工藤進英¹ 三澤将史¹ 神山勇太¹ 望月健一¹ 佐藤雄太¹ 櫻井達也¹ 前田康晴¹ 林武雅¹ 若村邦彦¹ 宮地英行¹ 澤田成彦¹ 馬場俊之¹ 石田文生¹ 根本哲生²

所属機関： ¹昭和大学横浜市北部病院消化器センター ²昭和大学横浜市北部病院臨床病理診断科

ページ範囲：P.170 - P.178

要旨●超拡大内視鏡（EC）は，腺腔と核を最大520倍率まで可視化し，生体内で顕微鏡レベルの核異型や構造異型の診断を可能にしたデバイスである．癌併存SSLは構造異型および核異型を認めるため，ECを用いることで高い精度の診断が期待される．今回，筆者らはEC観察後に切除されたSSLおよび癌併存SSLを対象に内視鏡所見，特にEC所見について検討した．その結果，通常内視鏡観察において平坦病変の一部に陥凹または隆起を認め，EC観察においてSSLを示唆する腺腔の開大所見，および腫瘍を示唆するEC2またはEC3の所見が観察される症例では，癌併存SSLを強く疑い積極的に切除することが望ましいと考えられた．

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