根治的内視鏡治療が可能な早期胃癌の診断

抄録

According to the recent progress of endoscopic treatment, some types of an early gastric cancer have been able to be treated radically with endoscopy. Methods of endoscopic treatment can be classified to endoscopic resection (ER) and non-endoscopic resection (non-ER). In ER, there are endoscopic polypectomy, strip biopsy and ERHSE and in non-ER, there are laser endoscopy, microwave coagulation treatment, heater probe coagulation and endoscopic injection of pure ethanol etc.. ER has the advantage in histological study on the removed lesion to non-ER, but has usually a limit in the size of lesion. On the hand, non-ER cannot remove the lesion and cannot study its histology, but can treat larger lesion than ER. For the indication of radical endoscopic treatment of an early gastric cancer, following factors are requested, as no lymph node metastasis and no massive invasion beyond the mucosal muscle. Macroscopic type, size and ulceration of the lesion are also important factors for the indication. Although exact diagnosis of lymph node metastasis in individual case is impossible, pathological study on large number of the lesion performed surgery has proved following types of the lesion without lymph node metastasis. These are 1) a type I in m invasion, regardless its size, 2) a type ha in m and sm, less than 2cm, 3) a type Ul (-) IIb ·IIc in m, regardless its size, a type Ul (-) IIc in sm, less than 3cm, 4) a type UI (+) IIc in m, less than 2cm. Here, these types are called an early gastric cancer with absolute indication, which have to betreated by endoscopy. The other types of the lesion should be treated principally with surgery. However, patients with the lesion and with high surgical risk or refusing surgery have to be treated by ER or non-ER. In these patients, the lesion over the indication of ER is a relative indication and have to be treated by non-ER. Recently, it is going to increase as endoscopic treatment for the lesion that the combination therapy of ER at first and then non-ER is performed or after ER in the meaning of diagnosis, non-ER or surgery is selected, if necessary.