| 特集名 | 大腸ESDとEMRのすみ分け | |
|---|---|---|
| 題名 | EMR/ESDの偶発症対策 (2) ESD | |
| 発刊年月 | 2010年 03月 | |
| 著者 | 為我井 芳郎 | 国立国際医療センター国府台病院消化器科 |
| 著者 | 工藤 恵子 | 国立国際医療センター国府台病院消化器科 |
| 著者 | 小池 貴志 | 国立国際医療センター国府台病院消化器科 |
| 著者 | 斎藤 幸夫 | 国立国際医療センター戸山病院外科 |
| 著者 | 矢野 秀朗 | 国立国際医療センター戸山病院外科 |
| 著者 | 竹下 恵美子 | 国立国際医療センター戸山病院外科 |
| 著者 | 西野 晴夫 | 松島クリニック |
| 著者 | 野沢 博 | 松島クリニック |
| 著者 | 辺見 英之 | 松島クリニック |
| 【 要旨 】 | 大腸ESDのもっとも重要な偶発症対策は穿孔対策であり，とくに粘膜下に線維化を有する病変はその危険性が高い．線維化は生検，治療手技，炎症などの非癌性と癌のSM浸潤に伴った癌性に分けられた．以上のうち索状─帯状の非癌性と軽度癌浸潤例は局注液が線維化間質に浸透し，剥離ラインに沿った剥離が可能であった．一方，スクリーン状(高度)線維化例は安全面から原則ESDの適応外であったが，穿孔予防でクリップをあらかじめ留置することにより安全なESDが可能であった．したがって線維化はESDの成否に関与し，成因，質，程度の分析と適応判断が偶発症予防において重要となる． | |
| Theme | Selection of the therapeutic methods (EMR or ESD) for colorectal tumor | |
|---|---|---|
| Title | Overcoming ESD colorectal tumor complications | |
| Author | Yoshiro Tamegai | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Keiko Kudo | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Takashi Koike | Department of Gastroenterology, Kohnodai Hospital, International Medical Center of Japan |
| Author | Yukio Saito | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Hideaki Yano | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Emiko Takeshita | Department of Surgery, Toyama Hospital, International Medical Center of Japan |
| Author | Haruo Nishino | 3Matsushima Clinic |
| Author | Hiroshi Nozawa | 3Matsushima Clinic |
| Author | Hideyuki Henmi | 3Matsushima Clinic |
| [ Summary ] | INTRODUCTION : We have successfully performed ESD for colorectal tumors without severe complications (perforation or postoperative bleeding). The likelihood of complications related to ESD depends on the presence of fibrosis in the submucosal (SM) layer. We report on a safe ESD technique and a countermeasure to avoid complications. AIMS AND METHODS : ESD was performed in 236 cases with 230 having colorectal neoplasms （male : female=141 : 89 ; mean age, 67.0 years) of these cases, 39 also had sm fibrosis. This study analyzed these lesions in order to establish a safe therapeutic strategy. RESULTS : In ESD cases, the average lesion size was 31.8 mm (range : 5-145 mm). We had only one case with a micro-perforation (0.4%), which was treated with clipping. Out of the 39 cases with SM fibrosis, 15 cases were considered to be related to cancer invasion, and 24 cases were considered to be unrelated to cancerous invasion. We classified the endoscopic findings as being 'string-like' or 'rope-like' with a mild degree of severity. 'Band-like' lesions were classified as moderate. Those considered to be 'screen-like' were thought to constitute severe degree fibrosis. White or brown areas, as well as abnormal vessels were identified in cases with SM cancer invasion. In cases accompanied by mild to moderate fibrosis, lesions should be dissected carefully just above the muscle layer. In cases considered severe, ESD is more difficult to treat because of the risk of perforation. CONCLUSION : The level of difficulty for performing ESD for colorectal tumor treatment depends on the degree of the fibrosis in the SM layer. In these cases, we must establish a therapeutic strategy in order to avoid complications related to ESD. |
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