| 特集名 | Barrett食道 | |
|---|---|---|
| 題名 | Barrett食道癌の治療 (1) 内視鏡下治療の適応と方法 | |
| 発刊年月 | 2007年 01月 | |
| 著者 | 小山 恒男 | 佐久総合病院胃腸科 |
| 著者 | 友利 彰寿 | 佐久総合病院胃腸科 |
| 著者 | 堀田 欣一 | 佐久総合病院胃腸科 |
| 著者 | 森田 周子 | 佐久総合病院胃腸科 |
| 著者 | 田中 雅樹 | 佐久総合病院胃腸科 |
| 著者 | 古立 真一 | 佐久総合病院胃腸科 |
| 著者 | 宮田 佳典 | 佐久総合病院胃腸科 |
| 【 要旨 】 | 本邦で開発されたESD (endoscopic submucosal dissection) は任意の範囲を正確に切除しうる優れた手技である．しかし，術前の側方進展範囲診断を誤ると，切除断端は陽性になる．食道扁平上皮癌の進展範囲はヨード染色にて容易に診断できるが，Barrett表在癌の進展範囲診断ははるかに時に難しい． Barrett食道は扁平上皮より厚く，粘膜下層に線維化を伴うことが多い．Barrett食道のESDと食道扁平上皮癌のESDとでは，その技術に大差はない．良い視野を確保し，直視下に正確な剥離を施行することが重要である． Barrett食道癌のESDでもっとも大切なことは，正確な術前診断である．ESDという優れた治療手段を用いても，術前の診断が誤っていると切除断端は陽性になる．ESD技術はすでに完成されており，今後の課題は正確な術前診断である． |
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| Theme | Barrett's Esophagus | |
|---|---|---|
| Title | Endoscopic Treatment of Barrett's Esophageal Cancer -- Indications and Methods | |
| Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
| Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
| Author | Kinichi Hotta | Department of Gastroenterology, Saku Central Hospital |
| Author | Shuko Morita | Department of Gastroenterology, Saku Central Hospital |
| Author | Masaki Tanaka | Department of Gastroenterology, Saku Central Hospital |
| Author | Shinichi Furutachi | Department of Gastroenterology, Saku Central Hospital |
| Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
| [ Summary ] | Endoscopic submucosal dissection (ESD) is a novel endoluminal surgery for superficial cancers. Any size or shape resected with ESD. The major indication for endoluminal surgery for esophageal cancer is cases without lymph node metastasis. There have only been a few reports cases of lymph node metastasis with superficial Barrett's esophagus. Bollschweiler reported the incidence of lymph node metastasis with mucosal Barrett's esophageal cancer to be zero. However, the rate for submucosal invasive Barrett's esophageal cancer was 41 %. Therefore, the major indication for endoluminal surgery for Barrett's esophageal cancer is considered to be intramucosal Barrett's cancers. Submucosal fibrosis associated with Barrett's esophagus is more severe than that seen with SCC, because the incidence of reflux esophagitis is higher in Barrett's esophagus. Therefore, greater ESD skill levels will be necessary for treatment of Barrett's esophageal cancer. A diagnosis of a lateral SCC extension is easier than that of Barrett's esophageal cancer, because the lateral extension of SCC may be diagnosed with iodine staining. Superficial lesions may be resected with ESD without limitations as to size or shape. However, if a lateral extension is misdiagnosed, the cut margin may still positive. Because of these factors a precise diagnosis before ESD is necessary. |
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