臨牀消化器内科 Vol.33 No.10(4-2)


特集名 十二指腸上皮性非乳頭部腫瘍の診療を巡って ― 現状と課題
題名 十二指腸上皮性非乳頭部腫瘍の診断を巡って (2) EMR
発刊年月 2018年 09月
著者 山本 頼正 昭和大学藤が丘病院消化器内科
【 要旨 】 近年,無症状で診断される表在性非乳頭部十二指腸腫瘍(SNADET)が増加している.十二指腸癌の5年生存率は胃癌,大腸癌よりも低く,SNADETの内視鏡的粘膜切除術(EMR)は早期治療の点から重要であり,その適応は原則として一括切除の可否,質的診断,腫瘍径,肉眼型,線維化の有無,年齢等を考慮して判断する.実際のEMR手技では,粘膜下局注,スネアリング,切除後潰瘍への処置など,十二指腸の特性を理解して行うことが必須であり,内視鏡的粘膜下層剥離術(ESD)を含むSNADETの内視鏡治療においてマスターすべき基本手技である.
Theme Diagnosis and Treatment of Non-ampullary Duodenal Epithelial Tumor -- Current Status and Issues
Title Endoscopic Mucosal Resection for Non-ampullary Duodenal Epithelial Tumor
Author Yorimasa Yamamoto Department of Gastroenterology, Showa University Fujigaoka Hospital
[ Summary ] Recently, an increasing number of patients with superficial non-ampullary duodenal epithelial tumor (SNADET) are asymptomatic. The 5-year survival rate of duodenal cancer is lower than that of stomach and colon cancer, and endoscopic mucosal resection (EMR) of SNADET is important from the viewpoint of early treatment of duodenal cancer. The indications for EMR to treat SNADET should be based on the possibility of R0 resection, qualitative diagnosis of the lesion, tumor diameter, gross type, presence or absence of fibrosis, and the patient's age. When performing EMR procedures, it is essential to clearly understand the characteristics of duodenal EMR such as submucosal injection, snaring, and treatment of the resected ulcer. EMR is a basic procedure used in the endoscopic treatment of SNADET including endoscopic submucosal dissection.
戻る