INTESTINE Vol.18 No.3(4-4-3)


特集名 今，変わるのか？ 大腸微小病変の取り扱い
題名 処置・治療 (4) Resect and Discard trialの是非 c．超拡大内視鏡の立場から
発刊年月 2014年 05月
著者 工藤 進英 昭和大学横浜市北部病院消化器センター
著者 森 悠一 昭和大学横浜市北部病院消化器センター
著者 若村 邦彦 昭和大学横浜市北部病院消化器センター
著者 一政 克朗 昭和大学横浜市北部病院消化器センター
著者 三澤 将史 昭和大学横浜市北部病院消化器センター
著者 工藤 豊樹 昭和大学横浜市北部病院消化器センター
著者 和田 祥城 昭和大学横浜市北部病院消化器センター／東京医科歯科大学光学医療診療部
著者 宮地 英行 昭和大学横浜市北部病院消化器センター
著者 井上 晴洋 昭和大学横浜市北部病院消化器センター
【 要旨 】 内視鏡診断の発展を背景に，微小大腸ポリープを“Resect and Discard”する考え方が欧米で提案されている．“Resect and Discard”が前提とするのは，確実な事前内視鏡的診断であるが，この点では超拡大内視鏡のような高い診断能を誇る内視鏡技術は注目すべきdeviceなのかもしれない．しかし，悪性ポテンシャルをもつ微小大腸ポリープ（自験例では約3％）を誤ってdiscardしてしまう危険性は無視できず，“Resect and Discard”の実現可能性についてはきわめて慎重な議論が必要である．
Theme Can we change to treat for diminutive colorectal polyp ?
Title Management of diminutive colon polyps using endocytoscopy
Author Shin-ei Kudo Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Yuichi Mori Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Kunihiko Wakamura Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Katsuro Ichimasa Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Masashi Misawa Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Toyoki Kudo Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Yoshiki Wada Digestive Disease Center, Showa University Northern Yokohama Hospital / Division of Endoscopy, Tokyo Medical and Dental University
Author Hideyuki Miyachi Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Haruhiro Inoue Digestive Disease Center, Showa University Northern Yokohama Hospital
[ Summary ] Recent advances in endoscopic imaging modalities allow precise real-time predictions of polyp histology in the colorectum. With this advance, the "Resect and Discard" strategy for management of diminutive colorectal polyps was proposed by a number of western researchers. This strategy necessitates an accurate endoscopic diagnosis in advance of treatment. Attention must also be paid to the benefit of significantly decreasing pathology-associated time, as well as costs. Endocytoscopy, which enables observation at 450-fold magnification levels during gastrointestinal endoscopy allowing on-site "optical biopsy", may become an efficient tool for this treatment strategy. Endocytoscopy can be employed to precisely discriminate diminutive adenomas from diminutive non-neoplastic polyps with sensitivity of 94 %, specificity of 93 %, and accuracy of 94 %. However, the "Resect and Discard" strategy possibly presents some risks of misdiagnosing advanced neoplasms (which were 3 % of diminutive colorectal polyps in our facility) and discarding them without pathological assessment. Therefore, very careful evaluation is necessary for validation of this strategy both domestically and internationally.
戻る