| 特集名 | 安全かつ効率的な大腸ESDを目指して | |
|---|---|---|
| 題名 | 大腸ESDの研修・トレーニングシステム (2) 当院における研修・トレーニングシステム | |
| 発刊年月 | 2013年 01月 | |
| 著者 | 大圃 研 | NTT東日本関東病院消化器内科 |
| 著者 | 木庭 郁朗 | 山鹿中央病院消化器科 |
| 著者 | 大野 亜希子 | NTT東日本関東病院消化器内科 |
| 著者 | 伊藤 高章 | NTT東日本関東病院消化器内科 |
| 著者 | 辻 陽介 | NTT東日本関東病院消化器内科 |
| 著者 | 千葉 秀幸 | 大森赤十字病院消化器内科 |
| 著者 | 大谷 友彦 | 東京慈恵会医科大学内視鏡科 |
| 著者 | 松橋 信行 | NTT東日本関東病院消化器内科 |
| 【 要旨 】 | 内視鏡的粘膜下層剝離術（ESD）の進歩は目覚ましく，2012年4月から大腸ESDも保険収載された．大腸ESDの研修には十分な知識と診断能力，大腸内視鏡処置一般における技術力が基本になる．上級医の手技を見学・観察して視野作りや手順を学び，介助をしつつデバイスの扱いを把握し，治療のイメージトレーニングをしていく．カンファレンスで適応やstrategyなどを十分練ってから実際の治療を行い，自身の手技動画を見直す．偶発症増多を回避するために，上級医がbackupし，安全・効果的な研修をすべきである． | |
| Theme | Aims to improve colorectal ESD safety and efficiency | |
|---|---|---|
| Title | ESD training programs | |
| Author | Ken Ohata | Department of Gastroenterology, Kanto Medical Center NTT |
| Author | Ikurou Koba | Department of Gastroenterology, Yamaga Chuo Hospital |
| Author | Akiko Ono | Department of Gastroenterology, Kanto Medical Center NTT |
| Author | Takafumi Ito | Department of Gastroenterology, Kanto Medical Center NTT |
| Author | Yosuke Tsuji | Department of Gastroenterology, Kanto Medical Center NTT |
| Author | Hideyuki Chiba | 3Department of Gastroenterology, Omori Red Cross Hospital |
| Author | Tomohiko Ohya | Department of Endoscopy, The Jikei University School of Medicine |
| Author | Nobuyuki Matsuhashi | Department of Gastroenterology, Kanto Medical Center NTT |
| [ Summary ] | Because of the anatomical and histological characteristics of the colorectal wall, ESD techniques are considered to be more difficult for treatment of colorectal lesions than for gastric neoplasms. However, colorectal ESD has gradually become more widely used with the development of various devices. Since April 2012, the cost of colorectal ESD has been covered by the national health insurance system in Japan. Colorectal ESD training systems teach learning diagnostic skills as well as general skills associated with therapeutic colonoscopy. Colorectal ESD training systems must include instructions on using devices, instrument positioning and planning procedures. Preoperative colonoscopy is important to produce images to formulate treatment strategies. Trainees are allowed to perform colorectal ESD only after mastering ESD processes. Experts should oversee trainees to prevent complications. The key element for these procedures is prevention of declines in clinical outcomes during initial treatment periods. The establishment of satisfactory training systems is essential to make ESD a reliable treatment option for gastrointestinal neoplasms. Our training system for colorectal ESD is outlined. Our training system for ESD may help extend the acceptance of this procedure. |
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