Sumiyama Kazuki, Kaise Mitsuru, Nakayoshi Takashi, Kato Masayuki, Mashiko Takahiro, Uchiyama Yujiro, Goda Kenichi, Hino Shoryoku, Nakamura Yasuyuki, Matsuda Koji, Mochizuki Keiko, Kawamura Muneo, Tajiri Hisao
Department of Endoscopy, The Jikei University School of Medicine, Tokyo, Japan.
Gastrointest Endosc. 2004 Jul;60(1):79-84. doi: 10.1016/s0016-5107(04)01285-4.
En bloc EMR is performed in Japan as a curative treatment for early stage gastric cancer. However, current methods of EMR are technically difficult and require proficiency in determining the extent of the cancer. This study assessed the feasibility of a new method to obviate these problems and to facilitate en bloc EMR.
The new method uses two types of endoscopes: a magnifying endoscope with a narrow band imaging system to enhance the definition of mucosal and microcirculatory structure, and an endoscope with multibending tip deflection to maintain orientation during EMR. Forty-two consecutive cases of mucosal gastric cancer treated by EMR were reviewed retrospectively. In 12 of these patients, 12 lesions that fulfilled guideline criteria for EMR were treated by the modified, en bloc EMR method of circumferential incision and snare resection by using the two endoscopes.
The rate of complete en bloc resection with the new method of EMR was 91.7%, (11/12). There was no major complication.
The new en bloc resection method for EMR with two endoscopes described here is feasible and may be a safe and a reliable technique for curative treatment of mucosal gastric cancer.
在日本，整块内镜黏膜切除术（EMR）被用作早期胃癌的一种根治性治疗方法。然而，目前的EMR方法在技术上具有挑战性，并且需要熟练掌握确定癌症范围的技能。本研究评估了一种新方法的可行性，该方法可避免这些问题并促进整块EMR。
新方法使用两种类型的内镜：一种带有窄带成像系统的放大内镜，以增强黏膜和微循环结构的清晰度；另一种是带有多弯曲尖端偏转功能的内镜，以便在EMR过程中保持方向。对42例连续接受EMR治疗的黏膜型胃癌病例进行了回顾性分析。在这些患者中，有12例患者的12个符合EMR指南标准的病变采用了改良的整块EMR方法进行治疗，即使用这两种内镜进行环形切口和圈套切除。
采用新的EMR方法整块切除的成功率为91.7%（11/12）。没有出现严重并发症。
本文所述的使用两种内镜的新型整块切除EMR方法是可行的，可能是一种安全可靠的黏膜型胃癌根治性治疗技术。
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