Endoscopic Mucosal Resection for Early Gastric Cancer.

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  • 早期胃癌に対する内視鏡的粘膜切除術
  • ソウキ イガン ニ タイスル ナイシキョウテキ ネンマク セツジョジュツ

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Endoscopic mucosal resection (EMR) is widely accepted in Japan as a curative treatment for early gastric cancer. Our indication criteria for EMR are as follows: (1) intestinal type mucosal cancer, without ulcerative findings, of any size, and (2) intestinal type mucosal cancer, with ulcerative findings, of less than 30mm. Although larger lesions have often been resected in multiple fragments, tumor should be removed in a single fragments. It is because, histological evaluation is often difficult due to burning along the cut-margins and uncertain reconstructions.<br>We developed a new instrument, the insulation-tipped diathermic knife. This seems to allow safe resection of a larger lesion in a single fragment. Among the complications of EMR, perforation is a big problem. We also developed the endoscopic clipping for perforation. In 4-6 days after clipping, the patient can start to eat. Based on our experience, it has become clear that EMR can promise the same favorable long-term survival rates as traditional therapy, as the criteria are strictly respected.

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