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

早期癌併存大腸SSLに対する内視鏡治療の注意点

著者： 岸田圭弘¹ 堀田欣一¹ 今井健一郎¹ 伊藤紗代¹ 髙田和典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.179 - P.188

文献概要

要旨●早期癌併存大腸SSLの内視鏡治療適応を判断し，適切な切除方法を選択するためには，内視鏡的質的診断，癌併存病変の内視鏡的深達度診断，内視鏡治療成績，そして病理組織学的診断に基づく治癒切除判定の各段階についての知見が必要である．今回，SSLDと早期癌併存SSLを対象とし，深達度診断と治療成績について検討した．深達度診断では，pT1b癌併存SSLでもJNET Type 3やV_I型高度不整pit patternなどの典型的所見がみられないことが診断を難しくすると考えられたが，浸潤癌（pT1a/pT1b）の診断においてはJNET Type 2B/3，V_I型pit pattern，non-lifting signが有用であった．治療成績では，スネア切除には分割切除例がある一方，ESDは全例で一括切除が可能であった．分割切除は内視鏡診断SSL例とnon-lifting sign陽性例に多く，明らかなdysplasiaや癌併存を疑う所見がなくても，non-lifting signが陽性の場合はESDを行うことが望ましいと考えられた．

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