Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1285
Peer-review started: June 2, 2021
First decision: July 1, 2021
Revised: July 11, 2021
Accepted: September 15, 2021
Article in press: September 15, 2021
Published online: October 27, 2021
Esophageal adenocarcinoma (EAC) derived from long-segment Barrett’s esophagus (LSBE) is extremely rare in Asia. LSBE-related EAC is often difficult to diagnose in the horizontal extent. If the tumor has spread throughout the LSBE, whole circumferential endoscopic submucosal dissection (ESD) should be performed, which is difficult to complete safely. Additionally, whole circumferential ESD can bring refractory postoperative stenosis. We hereby report a case of EAC involving the whole circumference of the LSBE, achieving complete endoscopic removal without complications.
An 85-year-old man with the chief complaint of dysphagia underwent esophagogastroduodenoscopy. We suspected a flat-type cancerous lesion that extended the whole circumference of the LSBE (C 3.5, M 4.0) using narrow-band imaging magnification endoscopy (NBI-M). We achieved circumferential en bloc resection of the lesion safely with special ESD techniques. Histology of the ESD specimens demonstrated that the superficial EAC extended the whole circumference of the LSBE, and papillary or well-differentiated tubular adenocarcinoma was confined in the lamina propria mucosa showing a vertical negative margin. To prevent post-ESD stenosis, we performed endoscopic local injection of steroids, followed by oral administration of steroids. There was no evidence of esophageal refractory stenosis or tumor recurrence 30 mo after ESD. In summary, we experienced a rare case of LSBE-related EAC. The horizontal tumor extent was accurately diagnosed by NBI-M. Additionally, we achieve whole circumferential ESD safely without postoperative refractory stenosis.
NBI-M, ESD, and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.
Core Tip: Esophageal adenocarcinoma (EAC) arising from long-segment Barrett’s esophagus is rare and tends to be diffuse. Preoperative diagnosis of the horizontal tumor extent and postoperative stenosis after endoscopic submucosal dissection (ESD) could be problematic in this case. We accurately diagnosed the horizontal extent of the EAC lesion by narrow-band imaging magnification endoscopy and achieved complete en bloc R0 resection via whole circumferential ESD. We also succeeded in preventing refractory stenosis after whole circumferential ESD by prophylactic steroid therapy combing local injection and oral administration.