内視鏡手術の現況 早期胃癌に対する内視鏡的粘膜下層剥離術

Abstract

Endoscopic submucosal dissection (ESD) is a new endoscopic treatment for early gastric cancer that enables complete resection of lesions in the lump. ESD has become widespread as a standard treatment because several devices, including high-frequency electro surgical units, injection solutions and endoscope with water jet, have been developed in Japan. Large lesions and lesions with an ulcer scar can be removed en bloc, and ESD has increased accordingly with the expanded indications. In addition, an accurate histopathological diagnosis can be made following en bloc resection. In this procedure, the circumferential mucosal incision around the lesion and the submucosa is dissected using an IT knife, hooking knife, electro-surgical snare (a thin type), flex knife or flush knife. In particular, the flush knife can emit a jet of water from the tip of a sheath that allows us to perform ESD efficiently. It is relatively safe for avoiding perforation and bleeding. However, ESD takes longer and requires advanced technical skill, and the incidence of major complications is higher in comparison with the standard EMR method. Therefore, it is desirable to learn all of the techniques and the characteristics of the devices and high-frequency units, as well as cutting, dissection and hemostasis in order to perform ESD safely.