高齢者早期胃癌に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）の安全性と有用性についての検討
背景：近年の内視鏡技術の向上や機器の開発により，早期胃癌（Early gastric cancer: ECG）に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）は一般的な治療法として確立している。現在では高齢者のECGに対してESDが広く行われているが，併存疾患が多く，偶発症の発生による全身状態の深刻な悪化が懸念される一方で，安全性や有用性に対する一定の見解は得られていない。 目的：当施設の胃ESDの治療成績から，高齢者に対するESDの安全性と有用性を検討する。 対象と方法：2006年1月から2016年12月までの間，当院にて胃ESDを...
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| Published in | 聖マリアンナ医科大学雑誌 Vol. 45; no. 4; pp. 271 - 279 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
学校法人 聖マリアンナ医科大学医学会
2018
St. Marianna University Society of Medical Science |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0387-2289 2189-0285 |
| DOI | 10.14963/stmari.45.271 |
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| Abstract | 背景：近年の内視鏡技術の向上や機器の開発により，早期胃癌（Early gastric cancer: ECG）に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）は一般的な治療法として確立している。現在では高齢者のECGに対してESDが広く行われているが，併存疾患が多く，偶発症の発生による全身状態の深刻な悪化が懸念される一方で，安全性や有用性に対する一定の見解は得られていない。 目的：当施設の胃ESDの治療成績から，高齢者に対するESDの安全性と有用性を検討する。 対象と方法：2006年1月から2016年12月までの間，当院にて胃ESDを施行した235症例261病変を対象とした。79歳以下を非高齢者群（Non-elderly: NE群），80歳以上を高齢者群（Elderly: E群）とし，retrospectiveに両群間の治療成績を比較検討した。 結果：全体での偶発症発生率は両群間に有意差は認めなかったが，内容別に検討するとE群にて肺炎が多く認められた（P=0.03）。一括切除率，完全一括切除率に有意差は認めなかったが，E群において有意に治癒切除率は低く（P=0.03），処置時間は長かった（P=0.03）。両群間の入院期間に差は認められなかった。 結論：高齢者早期胃癌に対するESDは肺炎に留意する必要はあるものの，偶発症全体の発症率に差異はなく，安全な治療遂行が可能である。 |
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| AbstractList | 背景：近年の内視鏡技術の向上や機器の開発により，早期胃癌（Early gastric cancer: ECG）に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）は一般的な治療法として確立している。現在では高齢者のECGに対してESDが広く行われているが，併存疾患が多く，偶発症の発生による全身状態の深刻な悪化が懸念される一方で，安全性や有用性に対する一定の見解は得られていない。 目的：当施設の胃ESDの治療成績から，高齢者に対するESDの安全性と有用性を検討する。 対象と方法：2006年1月から2016年12月までの間，当院にて胃ESDを施行した235症例261病変を対象とした。79歳以下を非高齢者群（Non-elderly: NE群），80歳以上を高齢者群（Elderly: E群）とし，retrospectiveに両群間の治療成績を比較検討した。 結果：全体での偶発症発生率は両群間に有意差は認めなかったが，内容別に検討するとE群にて肺炎が多く認められた（P=0.03）。一括切除率，完全一括切除率に有意差は認めなかったが，E群において有意に治癒切除率は低く（P=0.03），処置時間は長かった（P=0.03）。両群間の入院期間に差は認められなかった。 結論：高齢者早期胃癌に対するESDは肺炎に留意する必要はあるものの，偶発症全体の発症率に差異はなく，安全な治療遂行が可能である。 Background: With recent improvements in endoscopic techniques and development of related equipment, endoscopic submucosal dissection (ESD) has become an established treatment for early gastric cancer (EGC). Currently, ESD is widely performed to treat elderly patients with EGC. However, the prevalence of comorbidities raises concerns of adverse events, which can cause severe deterioration in the overall condition of elderly patients. Thus, a consensus on the safety and efficacy of ESD is yet to be reached.Aim: To investigate the safety and efficacy of ESD in elderly patients by analyzing records of patients who underwent gastric ESD.Subjects and Methods: The subjects of this study were 235 patients (261 lesions) who underwent gastric ESD at our hospital between January 2006 and December 2016. The subjects were categorized into two groups: the non-elderly (NE) group comprising patients aged <79 years and the elderly (E) group comprising patients aged≥80 years. Treatment outcomes of the two groups were compared retrospectively.Results: Although no significant differences were observed in the overall incidence rate of adverse events between the two groups, more cases of pneumonia were observed in the E group (p=0.03) when analyzed according to disease type. No significant differences were observed in the rate of en bloc or complete resection; however, compared with the NE group, the rate of curative resection was significantly lower in the E group (p=0.03), and the procedure time for curative resection also was longer (p=0.03). No differences were identified in the length of hospitalization between the two groups.Conclusion: Although the risk of pneumonia should be considered when performing ESD in elderly patients with EGC, no difference was found in the overall incidence rate of adverse events. Thus, it is possible to perform ESD safety in this patient population. 背景：近年の内視鏡技術の向上や機器の開発により，早期胃癌（Early gastric cancer: ECG）に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）は一般的な治療法として確立している。現在では高齢者のECGに対してESDが広く行われているが，併存疾患が多く，偶発症の発生による全身状態の深刻な悪化が懸念される一方で，安全性や有用性に対する一定の見解は得られていない。目的：当施設の胃ESDの治療成績から，高齢者に対するESDの安全性と有用性を検討する。対象と方法：2006年1月から2016年12月までの間，当院にて胃ESDを施行した235症例261病変を対象とした。79歳以下を非高齢者群（Non-elderly: NE群），80歳以上を高齢者群（Elderly: E群）とし，retrospectiveに両群間の治療成績を比較検討した。結果：全体での偶発症発生率は両群間に有意差は認めなかったが，内容別に検討するとE群にて肺炎が多く認められた（P=0.03）。一括切除率，完全一括切除率に有意差は認めなかったが，E群において有意に治癒切除率は低く（P=0.03），処置時間は長かった（P=0.03）。両群間の入院期間に差は認められなかった。結論：高齢者早期胃癌に対するESDは肺炎に留意する必要はあるものの，偶発症全体の発症率に差異はなく，安全な治療遂行が可能である。 |
| Author | 石井, 俊哉 平石, 哲也 奥瀬, 千晃 石郷岡, 晋也 森田, 望 末谷, 敬吾 伊東, 文生 薩田, 祐輔 鈴木, 通博 安田, 宏 |
| Author_FL | Yasuda Hiroshi Itoh Fumio Suetani Keigo Okuse Chiaki Hiraishi Tetsuya Ishii Toshiya Ishigooka Shinya Satta Yusuke Morita Nozomi Suzuki Michihiro |
| Author_FL_xml | – sequence: 1 fullname: Ishigooka Shinya – sequence: 2 fullname: Morita Nozomi – sequence: 3 fullname: Hiraishi Tetsuya – sequence: 4 fullname: Suetani Keigo – sequence: 5 fullname: Satta Yusuke – sequence: 6 fullname: Ishii Toshiya – sequence: 7 fullname: Okuse Chiaki – sequence: 8 fullname: Yasuda Hiroshi – sequence: 9 fullname: Suzuki Michihiro – sequence: 10 fullname: Itoh Fumio |
| Author_xml | – sequence: 1 fullname: 安田, 宏 organization: 聖マリアンナ医科大学 内科学（消化器・肝臓内科） – sequence: 1 fullname: 伊東, 文生 organization: 聖マリアンナ医科大学 内科学（消化器・肝臓内科） – sequence: 1 fullname: 平石, 哲也 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 鈴木, 通博 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 末谷, 敬吾 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 薩田, 祐輔 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 石井, 俊哉 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 石郷岡, 晋也 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 森田, 望 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） – sequence: 1 fullname: 奥瀬, 千晃 organization: 川崎市立多摩病院 内科学（消化器・肝臓内科） |
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| References_xml | – reference: 9) 日本胃癌学会編．胃癌治療ガイドライン（医師用），第4版，金原出版，東京，2014． – reference: 12) Takizawa K, Oda I, Gotoda T, Yokoi C, Matsuda T, Saito Y, Saito D, Ono H. Routine coagulation of visible vessels may prevent delayed bleeding after endoscopic submucosal dissection-an analysis of risk factors. Endoscopy 2008; 40: 179–183. – reference: 5) Nakamura K, Ueyama T, Yao T, Xuan ZX, Ambe K, Yakeishi Y, Matsukuma A, Enjoji M. Pathology and prognosis of gastric carcinoma. Finding in 10,000 patients who underwent primary gastrectmy. Cancer 1992; 70: 1030–1037. – reference: 18) Gotoda T. Endoscopic resection of early gastric cancer. Gastric Cancer 2007; 10: 1–11. – reference: 2) Suzuki H, Oda I, Abe S, Sekiguchi M, Mori G, Nonaka S, Yoshinaga S, Saito Y. High rate of 5-year survival among patients with early gastric cancer undergoing curative endoscopic submucosal dissection. Gastric Cancer 2016; 19: 198–205. – reference: 23) Nagano H, Ohyama S, Fukunaga T, Seto Y, Fujisaki J, Yamaguchi T, Yamamoto N, Kato Y, Yamaguchi A. Indications for gastrectomy after imcomplete EMR for early gastric cancer. Gastric Cancer 2005; 8: 149–154. – reference: 13) Goto O, Fujishiro M, Kodashima S, Ono S, Niimi K, Hirano K, Yamamichi N, Koike K. A second-look endoscopy after endoscopic submucosal dissection for gastric epithelial neoplasm may be unnecessary: A retrospective analysis of postendoscopic submucosal dissection bleeding. Gastrointest Endosc 2010; 71: 241–248. – reference: 17) Shiba M, Higuchi K, Kadouchi K, Montani A, Yamamori K, Okazaki H, Taguchi M, Wada T, Itani A, Watanabe T, Tominaga K, Fujiwara Y, Hayashi T, Tsumura K, Arakawa T. Risk factors for bleeding after endoscopic mucosal resection. World J Gastroenterol 2005; 11: 7335–7339. – reference: 4) Gotoda T, Iwasaki M, Kusano C, Seewald S, Oda I. 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| Snippet | 背景：近年の内視鏡技術の向上や機器の開発により，早期胃癌（Early gastric cancer: ECG）に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）は... Background: With recent improvements in endoscopic techniques and development of related equipment, endoscopic submucosal dissection (ESD) has become an... |
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| SubjectTerms | 併存疾患 内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD） 早期胃癌 高齢者 |
| Title | 高齢者早期胃癌に対する内視鏡的粘膜下層剥離術（Endoscopic Submucosal Dissection: ESD）の安全性と有用性についての検討 |
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| ispartofPNX | 聖マリアンナ医科大学雑誌, 2018, Vol.45(4), pp.271-279 |
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