2017 Volume 59 Issue 3 Pages 265-271
Barrett’s esophagus, a precursor of esophageal adenocarcinoma, occurs due to reflux of duodenal contents after total gastrectomy. We herein report a case of adenocarcinoma arising in long-segment Barrett’s esophagus 51 years after total gastrectomy. A 70-year-old woman who had undergone total gastrectomy with Billroth Ⅱ esophagojejunostomy reconstruction and Braun’s anastomosis for a gastric ulcer at 19 years of age, was referred to our hospital for detailed examination of a protruded lesion in the esophagus. Endoscopic examination revealed long-segment Barrett’s esophagus beginning 17 cm from the incisors and continuing to the esophagojejunostomy site, and a slightly reddish protruded lesion, 14 mm in diameter, that was located 18 cm from the incisors. Biopsy specimens taken from the lesion disclosed adenocarcinoma. We diagnosed it as adenocarcinoma in Barrett’s esophagus and performed endoscopic submucosal dissection. Histopathologic examination of cross-sections revealed well-differentiated tubular adenocarcinoma invading down to the deep muscularis mucosae. The surrounding esophageal mucosa was lined with columnar epithelium of intestinal type. The patient has continued to be followed frequently and has been recurrence-free for 2 years. Careful surveillance is recommended for patients with long-segment Barrett’s esophagus after total gastrectomy in order to detect adenocarcinoma early.
