阿部圭一朗先生の論文が、World Journal of Gastrointestinal Surgery誌(Journal Citation Reports Impact Factor 2020 = 2.582)にpublishされました。
World J Gastrointest Surg. 2021 Oct 27;13(10):1285-1292. 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
PMID: 34754396 PMCID: PMC8554727 DOI: 10.4240/wjgs.v13.i10.1285
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: Case report; Endoscopic submucosal dissection; Long-segment Barrett’s esophagus; Magnification endoscopy; Steroid; Superficial esophageal adenocarcinoma.