Abe Keiichiro, Goda Kenichi, Kanamori Akira, Suzuki Tsunehiro, Yamamiya Akira, Takimoto Yoichi, Arisaka Takahiro, Hoshi Koki, Sugaya Takeshi, Majima Yuichi, Tominaga Keiichi, Iijima Makoto, Hirooka Shinichi, Yamagishi Hidetsugu, Irisawa Atsushi
Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan.
Department of Pathology, The Jikei University School of Medicine, Nishishimbashi 105-8471, Tokyo, Japan.
World J Gastrointest Surg. 2021 Oct 27;13(10):1285-1292. doi: 10.4240/wjgs.v13.i10.1285.
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.
源自长段巴雷特食管（LSBE）的食管腺癌（EAC）在亚洲极为罕见。与LSBE相关的EAC在横向范围上通常难以诊断。如果肿瘤已扩散至整个LSBE，则应进行全周内镜黏膜下剥离术（ESD），但这很难安全完成。此外，全周ESD会导致难治性术后狭窄。我们在此报告一例累及整个LSBE周径的EAC病例，实现了内镜下完全切除且无并发症。
一名85岁男性因吞咽困难为主诉接受了食管胃十二指肠镜检查。我们使用窄带成像放大内镜（NBI-M）怀疑有一个扁平型癌性病变，其累及LSBE的整个周径（C 3.5，M 4.0）。我们通过特殊的ESD技术安全地实现了病变的全周整块切除。ESD标本的组织学检查表明，浅表EAC累及LSBE的整个周径，乳头状或高分化管状腺癌局限于黏膜固有层，垂直切缘阴性。为预防ESD术后狭窄，我们进行了内镜下局部注射类固醇，随后口服类固醇。ESD术后30个月没有食管难治性狭窄或肿瘤复发的证据。总之，我们遇到了一例罕见的与LSBE相关的EAC病例。通过NBI-M准确诊断了肿瘤的横向范围。此外，我们安全地完成了全周ESD，且无术后难治性狭窄。
NBI-M、ESD和类固醇治疗能够实现浅表全周LSBE相关EAC的根治性切除，且无难治性术后狭窄。
