より大きな病変の一括切除をめざした新しいEMR手技 : 切開・剥離法 : 早期胃癌のEMR適応拡大に向けて

The standard indication of EMR for early gastric cancer in Japan is intra-mucosal cancer without ulcerative finding, histologically differentiated type, and less than 20 mm in diameter. Recently, in order to perform en block resection of early gastric cancer more than 20 mm in diameter and achieve histological evaluation precisely, several endoscopists have reported new EMR methods (cut and exfoliate method) using not only needle knife but also new devices such as IT knife, hooking knife and/or flex knife to cut around the lesion and exfoliate submucosa. From January 2001 to December 2002, we attempted to en bloc EMRs using needle knife, IT knife and/or hooking knife for 60 gastric cancers after informed concent, 40 lesions were according to the standard indication (group A) and 20 were not (group B). En bloc resection rates of group A and B were 82.5% (33/40) and 65.0% (13/20), respectively, these rates are higher than that of conventional methods (strip biopsy, aspiration method et al ). In the near feature, these advanced EMR techniques enable us to expand the indication criteria for early gastric cancer widely based on the results of analysis of lymph-node metastasis and prognostic data after EMR.