Saad Aida, Arnouk Joyce, Khorasani-Zadeh Arshia, Seth Monika, Zakharia Kais
Department of Medicine, University of Massachusetts Chan Medical School-Baystate Medical Center, Springfield, Massachusetts, USA.
Department of Pathology, Baystate Medical Center, Springfield, Massachusetts, USA.
VideoGIE. 2025 May 27;10(9):448-451. doi: 10.1016/j.vgie.2025.05.001. eCollection 2025 Sep.
Barrett's esophagus (BE) is a recognized precursor to esophageal adenocarcinoma (EAC), with an annual progression risk of up to 7% in cases involving high-grade dysplasia (HGD). Endoscopic therapy is the standard treatment for dysplastic BE and early-stage EAC, typically involving ablation techniques, such as radiofrequency ablation and cryotherapy, for flat BE and endoscopic resection methods, including EMR and more recently endoscopic submucosal dissection (ESD), for nodular lesions.
This article describes the case of a patient with an ultralong segment of BE (14 cm) and multifocal EAC who was successfully treated with circumferential ESD.
A complete en bloc resection of a 16-cm segment was achieved. Histopathologic analysis confirmed the presence of BE with HGD and multifocal EAC (T1b). Although the patient developed an esophageal stricture postprocedure, it was effectively managed endoscopically.
The patient is currently doing well and remains under routine endoscopic and radiographic surveillance. Circumferential ESD represents a safe and effective approach for the endoscopic resection of extensive BE and early EAC and should be considered a viable alternative to surgical intervention.
巴雷特食管（BE）是公认的食管腺癌（EAC）的癌前病变，在伴有高级别异型增生（HGD）的病例中，每年进展风险高达7%。内镜治疗是异型增生性BE和早期EAC的标准治疗方法，对于扁平BE通常采用消融技术，如射频消融和冷冻疗法，对于结节性病变则采用内镜切除方法，包括内镜黏膜切除术（EMR）以及最近的内镜黏膜下剥离术（ESD）。
本文描述了一例超长节段BE（14 cm）合并多灶性EAC患者经环周ESD成功治疗的病例。
实现了16 cm节段的完整整块切除。组织病理学分析证实存在伴有HGD的BE和多灶性EAC（T1b）。尽管患者术后出现食管狭窄，但通过内镜有效处理。
该患者目前情况良好，仍在接受常规内镜和影像学监测。环周ESD是广泛BE和早期EAC内镜切除的一种安全有效的方法，应被视为手术干预的可行替代方案。
