胃と腸59巻3号

2024年03月発行

今月の主題 上皮下発育を呈する食道病変の診断 主題

食道上皮下病変のEUS-FNA診断

著者： 奥野のぞみ¹ 原和生¹ 田近正洋² 水野伸匡¹ 田中努² 羽場真¹ 桑原崇通¹ 山田啓策² 伊藤信仁² 高木暁広² 福井淑崇¹ 浦田美菜子¹ 近藤高¹ 山本嘉太郎¹

所属機関： ¹愛知県がんセンター消化器内科部 ²愛知県がんセンター内視鏡部

ページ範囲：P.339 - P.349

要旨●消化管上皮下病変（gastrointestinal subepithelial lesions ; GISELs）は上下部内視鏡検査において，偶発的に発見されることも多く，日常診療においてしばしば遭遇する．病変の主座が上皮下に存在し，表面は正常上皮で覆われているため，通常観察のみでの画像診断は困難であり，通常の内視鏡下鉗子生検では病理組織学的診断も困難な場合が多い．EUS-FNAは，GISELsに対して安全かつ正確に病理組織学的診断ができる有用な検査法であり，本稿では食道上皮下病変に対するEUS-FNAについて解説する．

参考文献

1）原田昇，神津照雄，大島郁也，他．超音波内視鏡下穿刺法の基礎的研究（第1報）．Gastroenterol Endosc　33：1657-1661, 1663, 1991

2）Vilmann P, Jacobsen GK, Henriksen FW, et al. Endoscopic ultrasonography with guided fine needle aspiration biopsy in pancreatic disease. Gastrointest Endosc　38：172-173, 1992

3）Ikeda G, Hijioka S, Nagashio Y, et al. Fine-needle biopsy with 19G needle is effective in combination with endoscopic ultrasound-guided tissue acquisition for genomic profiling of unresectable pancreatic cancer. Dig Endosc　35：124-133, 2023

4）Okuno N, Hara K, Mizuno N, et al. Clinical utility of endoscopic ultrasound-guided tissue acquisition for comprehensive genomic profiling of pancreatic cancer. Clin Endosc　56：221-228, 2023

5）Polkowski M. Endoscopic ultrasound and endoscopic ultrasound-guided fine-needle biopsy for the diagnosis of malignant submucosal tumors. Endoscopy　37：635-645, 2005

6）Miettinen M, Majidi M, Lasota J. Pathology and diagnostic criteria of gastrointestinal stromal tumors（GISTs）：a review. Eur J Cancer　38（Suppl 5）：S39-51, 2002

7）Demetri GD, Benjamin RS, Blanke CD, et al. NCCN Task Force report：management of patients with gastrointestinal stromal tumor（GIST）--update of the NCCN clinical practice guidelines. J Natl Compr Canc Netw　5（Suppl 2）：S1-29 ; quiz S30, 2007

8）日本癌治療学会（編）．GIST診療ガイドライン，第4版．金原出版，2022

9）Gomes AL, Bardales RH, Milanezi F, et al. Molecular analysis of c-Kit and PDGFRA in GISTs diagnosed by EUS. Am J Clin Pathol　127：89-96, 2007

10）Sekine M, Imaoka H, Mizuno N, et al. Clinical course of gastrointestinal stromal tumor diagnosed by endoscopic ultrasound-guided fine-needle aspiration. Dig Endosc　27：44-52, 2015

11）Yamabe A, Irisawa A, Bhutani MS, et al. Usefulness of endoscopic ultrasound-guided fine-needle aspiration with a forward-viewing and curved linear-array echoendoscope for small gastrointestinal subepithelial lesions. Endosc Int Open　3：E161-164, 2015

12）Akahoshi K, Oya M, Koga T, et al. Clinical usefulness of endoscopic ultrasound-guided fine needle aspiration for gastric subepithelial lesions smaller than 2cm. J Gastrointestin Liver Dis　23：405-412, 2014

13）Aso A, Ihara E, Kubo H, et al. Gastric gastrointestinal stromal tumor smaller than 20mm with liver metastasis. Clin J Gastroenterol　6：29-32, 2013

14）藤本一眞，藤城光弘，加藤元嗣，他．抗血栓薬服用者に対する消化器内視鏡診療ガイドライン．Gastroenterol Endosc　54：2073-2102, 2012

15）加藤元嗣，上堂文也，掃本誠治，他．抗血栓薬服用者に対する消化器内視鏡診療ガイドライン　直接経口抗凝固薬（DOAC）を含めた抗凝固薬に関する追補2017．Gastroenterol Endosc　59：1547-1558, 2017

16）Committee ASoP, Khashab MA, Chithadi KV, et al. Antibiotic prophylaxis for GI endoscopy. Gastrointest Endosc　81：81-89, 2015

17）Song TJ, Kim JH, Lee SS, et al. The prospective randomized, controlled trial of endoscopic ultrasound-guided fine-needle aspiration using 22G and 19G aspiration needles for solid pancreatic or peripancreatic masses. Am J Gastroenterol　105：1739-1745, 2010

18）Polkowski M, Larghi A, Weynand B, et al. Learning, techniques, and complications of endoscopic ultrasound（EUS）-guided sampling in gastroenterology：European Society of Gastrointestinal Endoscopy（ESGE）Technical Guideline. Endoscopy　44：190-206, 2012

19）Inoue T, Okumura F, Sano H, et al. Impact of endoscopic ultrasound-guided fine-needle biopsy on the diagnosis of subepithelial tumors：A propensity score-matching analysis. Dig Endosc　31：156-163, 2019

20）Iwai T, Kida M, Imaizumi H, et al. Randomized crossover trial comparing EUS-guided fine-needle aspiration with EUS-guided fine-needle biopsy for gastric subepithelial tumors. Diagn Cytopathol　46：228-233, 2018

21）Nagai K, Sofuni A, Tsuchiya T, et al. Efficacy of the Franseen needle for diagnosing gastrointestinal submucosal lesions including small tumors. Endosc Ultrasound　10：424-430, 2021

22）Takasumi M, Hikichi T, Hashimoto M, et al. Usefulness of a Fork-Tip Needle in Endoscopic Ultrasound-Guided Fine-Needle Biopsy for Gastric Subepithelial Lesions. Diagnostics（Basel）11：1883, 2021

23）Han JP, Lee TH, Hong SJ, et al. EUS-guided FNA and FNB after on-site cytological evaluation in gastric subepithelial tumors. J Dig Dis　17：582-587, 2016

24）奥野のぞみ，原和生，田近正洋，他．消化管粘膜下腫瘍のEUS診断—EUS-FNAを含めて．胃と腸　53：1756-1767, 2018

25）原和生，奥野のぞみ，桑原崇通，他．胆膵内視鏡—診断：EUS-FNA．消内視鏡　29：593-596, 2017

26）奥野のぞみ，水野伸匡，桑原崇通，他．消化管粘膜下腫瘍に対するEUS-FNAの実際．臨消内科　33：1485-1492, 2018

27）Hébert-Magee S, Bae S, Varadarajulu S, et al. The presence of a cytopathologist increases the diagnostic accuracy of endoscopic ultrasound-guided fine needle aspiration cytology for pancreatic adenocarcinoma：a meta-analysis. Cytopathology　24：159-171, 2013

28）Tamura T, Yamashita Y, Ueda K, et al. Rapid on-site evaluation by endosonographers during endoscopic ultrasonography-guided fine-needle aspiration for diagnosis of gastrointestinal stromal tumors. Clin Endosc　50：372-378, 2017

29）Bang JY, Hebert-Magee S, Navaneethan U, et al. Randomized trial comparing the Franseen and Fork-tip needles for EUS-guided fine-needle biopsy sampling of solid pancreatic mass lesions. Gastrointest Endosc　87：1432-1438, 2018

30）Iwashita T, Yasuda I, Mukai T, et al. Macroscopic on-site quality evaluation of biopsy specimens to improve the diagnostic accuracy during EUS-guided FNA using a 19-gauge needle for solid lesions：a single-center prospective pilot study（MOSE study）. Gastrointest Endosc　81：177-185, 2015

31）Kanno A, Yasuda I, Irisawa A, et al. Adverse events of endoscopic ultrasound-guided fine-needle aspiration for histologic diagnosis in Japanese tertiary centers：Multicenter retrospective study. Dig Endosc　33：1146-1157, 2021