Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2021; 13(10): 1285-1292
Published online Oct 27, 2021. doi: 10.4240/wjgs.v13.i10.1285
Whole circumferential endoscopic submucosal dissection of superficial adenocarcinoma in long-segment Barrett's esophagus: A case report
Keiichiro Abe, Kenichi Goda, Akira Kanamori, Tsunehiro Suzuki, Akira Yamamiya, Yoichi Takimoto, Takahiro Arisaka, Koki Hoshi, Takeshi Sugaya, Yuichi Majima, Keiichi Tominaga, Makoto Iijima, Shinichi Hirooka, Hidetsugu Yamagishi, Atsushi Irisawa
Keiichiro Abe, Kenichi Goda, Akira Kanamori, Tsunehiro Suzuki, Akira Yamamiya, Yoichi Takimoto, Takahiro Arisaka, Koki Hoshi, Takeshi Sugaya, Yuichi Majima, Keiichi Tominaga, Makoto Iijima, Atsushi Irisawa, Department of Gastroenterology, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
Shinichi Hirooka, Department of Pathology, The Jikei University School of Medicine, Nishishimbashi 105-8471, Tokyo, Japan
Hidetsugu Yamagishi, Academic Institutional Research Center, Dokkyo Medical University, Mibu 321-0293, Tochigi, Japan
Author contributions: Abe K and Goda K wrote the manuscript; Kanamori A, Suzuki T, Yamamiya A, Arisaka T, Sugaya T, Majima Y, Tominaga K, Iijima M, and Irisawa A contributed to the manuscript discussion and reviewed the manuscript; Hirooka S and Yamagishi H established pathological diagnosis.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kenichi Goda, MD, PhD, Professor, Department of Gastroenterology, Dokkyo Medical University, 880 Kitakobayshi, Mibu 321-0293, Tochigi, Japan. goda@dokkyomed.ac.jp
Received: June 2, 2021
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
Abstract
BACKGROUND

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.

CASE SUMMARY

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.

CONCLUSION

NBI-M, ESD, and steroid therapy enabled the curative resection of superficial full circumferential LSBE-related EAC without refractory postoperative stenosis.

Keywords: Endoscopic submucosal dissection, Long-segment Barrett's esophagus, Superficial esophageal adenocarcinoma, Steroid, Magnification endoscopy, Case report

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.