Nakachi Kenichiro, Maekita Takao, Deguchi Hisanobu, Kimura Masatomo, Iguchi Mikitaka, Yoshida Satoshi, Kitano Masayuki
Gastroenterological Medicine Kameda Medical Center Kamogawa Chiba Japan.
Department of Gastroenterology Wakayama Medical University Wakayama Japan.
DEN Open. 2022 Dec 30;3(1):e202. doi: 10.1002/deo2.202. eCollection 2023 Apr.
Esophageal varices (EVs) are often treated using endoscopic injection sclerotherapy. Endoscopic submucosal dissection (ESD) has been used for early esophageal epithelial neoplasia worldwide. We report a case of early esophageal squamous cell carcinoma (ESCC) that occurred over EVs, in which the EVs were treated with endoscopic injection sclerotherapy before the early ESCC was treated with endoscopic submucosal dissection. Argon plasma coagulation was finally performed to prevent the recurrence of varices. No serious complications, such as severe bleeding or perforation, were observed. Histopathological examination revealed submucosal veins occluded with an organized thrombus for which endoscopic injection sclerotherapy with an intravariceal injection of sclerosant had been performed, but no fibrosis was observed outside the blood vessels. This explains that the injected sclerosant into EVs did not cause any tissue reaction like fibrosis in the submucosa surrounding the vein, which may have made endoscopic submucosal dissection safer and easier. Varices have not recurred, and ESCC has also not recurred for 5 years. We demonstrated a successful treatment of ESCC on EVs and no submucosal fibrosis other than inside the occluded vessels and verified it histologically.
食管静脉曲张（EVs）通常采用内镜注射硬化疗法进行治疗。内镜下黏膜剥离术（ESD）已在全球范围内用于早期食管上皮肿瘤的治疗。我们报告了1例发生在EVs上的早期食管鳞状细胞癌（ESCC）病例，其中在早期ESCC接受内镜下黏膜剥离术治疗之前，先采用内镜注射硬化疗法对EVs进行了治疗。最后进行氩离子凝固术以预防静脉曲张复发。未观察到严重出血或穿孔等严重并发症。组织病理学检查显示，黏膜下静脉被机化血栓阻塞，已进行了内镜下静脉曲张内注射硬化剂的注射硬化疗法，但血管外未观察到纤维化。这说明，向EVs内注射的硬化剂未在静脉周围的黏膜下层引起任何如纤维化的组织反应，这可能使内镜下黏膜剥离术更安全、更容易。静脉曲张未复发，ESCC也已5年未复发。我们展示了对EVs上的ESCC的成功治疗，且除了阻塞血管内部外未出现黏膜下纤维化，并通过组织学进行了验证。
