| 特集名 | ESD・NOTESの将来展望―消化器内視鏡治療の最前線 | |
|---|---|---|
| 題名 | ESDの現況と課題 (2) 胃ESD | |
| 発刊年月 | 2011年 03月 | |
| 著者 | 小田 一郎 | 国立がん研究センター中央病院消化管内視鏡科 |
| 著者 | 鈴木 晴久 | 国立がん研究センター中央病院消化管内視鏡科 |
| 著者 | 吉永 繁高 | 国立がん研究センター中央病院消化管内視鏡科 |
| 【 要旨 】 | 胃内視鏡的粘膜下層剥離術（ESD）成績の報告より，今後の課題について考察した．比較的低率な一括完全切除率，120分を超える治療時間，Hb値2g/dl以上低下，穿孔は，U or M領域，大きな病変，UL(＋)病変に多く，それらは技術的にさらなる向上を要する困難病変と考えられた．治癒切除は83％で，術前診断別には絶対適応病変に対しては90％，適応拡大のUL(−)，20mmを超える病変で69％，UL(＋)，30mm以下の病変で74％であった．非治癒切除例の内訳をみると，水平断端のみ陽性であった病変より，結果的に治癒切除基準外であった病変が大多数であり，深達度，UL，腫瘍径，組織型の診断などの的確な内視鏡診断，生検診断による改善が望まれる．また，多施設での長期成績の集積も重点課題と考える． | |
| Theme | Future Perspectives of Therapeutic Endoscopy Such as ESD and NOTES | |
|---|---|---|
| Title | Gastric ESD : Current Status and Unresolved Issues | |
| Author | Ichiro Oda | Endoscopy Division, National Cancer Center Hospital |
| Author | Haruhisa Suzuki | Endoscopy Division, National Cancer Center Hospital |
| Author | Shigetaka Yoshinaga | Endoscopy Division, National Cancer Center Hospital |
| [ Summary ] | The use of gastric endoscopic submucosal dissection (ESD) has become widespread in Japan, however, there are still some unresolved issues concerning ESD. We discuss these issues based on our gastric ESD results. The first, technical difficulty：lesions in the upper or middle thirds of the stomach, larger lesions and lesions with ulcer findings are contributing factors for increased technical difficulty from the viewpoint of a lower rate of enbloc resections with tumor-free margins, longer operation times>120 minutes, more frequent decreases in Hb levels> 2 g/dl and a greater risk of perforations. The second, non-curative resections resulting from diagnostic inaccuracy：15 % of ESD patients experienced histologically non-curative resections including those with positive lateral margins only (11.5 %) and those with possible risks of lymph-node metastasis (88.5 %) because of SM2 invasion, predominantly undifferentiated type lesions, positive lymphatic and/or venous invasion, intramucosal cancers>30 mm in size with ulcer findings and SM1 lesions >30 mm in size. The third, long-term outcomes : we recently reported in a retrospective study on long-term outcomes of our ESD case series that patients who underwent ESD based on the expanded criteria had similar long-term survival rate to those treated according to the guideline criteria. However, a prospective multicenter study on long-term outcomes of gastric ESDs is essential. |
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