INTESTINE Vol.14 No.2(3-2)


特集名 大腸ESDとEMRのすみ分け
題名 EMRの必要性と手技のコツ/ピットフォール (2) 大腸EMRスネアの選択
発刊年月 2010年 03月
著者 山野 泰穂 秋田赤十字病院消化器病センター
著者 吉川 健二郎 秋田赤十字病院消化器病センター
著者 木村 友昭 秋田赤十字病院消化器病センター
著者 加藤 隆介 秋田赤十字病院消化器病センター
著者 原田 拓 秋田赤十字病院消化器病センター
著者 石郷岡 晋也 秋田赤十字病院消化器病センター
著者 澤谷 学 秋田赤十字病院消化器病センター
著者 高木 亮 秋田赤十字病院消化器病センター
著者 佐藤 健太郎 秋田赤十字病院消化器病センター
【 要旨 】 大腸EMRにおける適切なスネア選択に関して,われわれは摩擦力に着目して理論的に考察した.摩擦力は垂直抗力,すなわちスネアを押し当てた加重に規定される.われわれは二つの条件〔水平加重(HPW)と,跳ね上がり加重(RPW)〕で,市販されている7種類のスネアに対して測定した結果スパイラルスネア,スネアマスターにおいて摩擦力が強く発揮されることが認められ,EMRに適したスネアとして有効であることが示された.
Theme Selection of the therapeutic methods (EMR or ESD) for colorectal tumor
Title Selection of snares for endoscopic mucosal resection, in terms of physical efficacy
Author Hiro-o Yamano Division of Gastroenterology, Akita Red Cross Hospital
Author Kenjiro Yoshikawa Division of Gastroenterology, Akita Red Cross Hospital
Author Tomoaki Kimura Division of Gastroenterology, Akita Red Cross Hospital
Author Ryusuke Kato Division of Gastroenterology, Akita Red Cross Hospital
Author Taku Harada Division of Gastroenterology, Akita Red Cross Hospital
Author Shinya Ishigooka Division of Gastroenterology, Akita Red Cross Hospital
Author Manabu Sawaya Division of Gastroenterology, Akita Red Cross Hospital
Author Ryo Takagi Division of Gastroenterology, Akita Red Cross Hospital
Author Kentaro Sato Division of Gastroenterology, Akita Red Cross Hospital
[ Summary ] There are various types of snares for endoscopic mucosal resection (EMR). Some endoscopists may choose a snare according to their personal preferences, but we supposed some physical factors were behind those preferences. In this paper, we raise the questions, "What is the best snare for EMR?", and "What are the reasons for those preferences?". In terms of dynamics, the most important element was considered to be vertical force, which may be applied to the mucosa through the snare. We considered two situations ; the first was one in which we keep the tool horizontal facing the loop snare (we defined it as the HPW ; horizontal faced position weight). The other situation was where these was a raised position (we defined it as RPW). We also inspected these forces for seven different snares, and calculated the "effective range" which was termed RPW minus HPW as an average. The results demonstrated that both "Spiral snare" and "Snare Master" showed higher ranges of efficacy than other snares for HPW, RPW and in terms of "effective range". Based on our study, we judged them as the best snares for EMR in terms of physics and logicality.
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