A CASE OF CAUTERIZATION THERAPY FOR BARRETT'S EPITHELIUM WHICH EXPANDED AFTER ENDOSCOPIC MUCOSAL RESECTION FOR MUCOSAL AENOCARCINOMA

Abstract

A 57-year-old man who had a history of ref lux esophagitis visited our hospital complaining heartburn afresh. Gastrointestinal endoscopic examination revealed short segment Barrett's esophagus and a small depressed lesion in Barrett's epithelium. Biopsy specimen from the depressed lesion showed differentiated adenocarcinoma histologically. Because it was thought as mucosal carcinoma, endoscopic mucosal resection (EMR) was performed. The EMR specimen showed well differentiated adenocarcinoma within the mucosal layer, intestinal metaplastic epithelium around the carcinoma and proper esophageal glands in the submucosal layer below the carcinoma histologically. So the depressed lesion was regarded as Barrett's adenocarcinoma. Then, follow-up endoscopic examination revealed expansion of residual Barrett's epithelium. Biopsy specimen from it showed no dysplasia or carcinoma but intestinal metaplastic epithelium histologically, so cauterization therapy with argon plasma coagulation for it was performed to prevent recurrence of Barrett's adenocarcinoma. Barrett's epithelium was replaced with squamous epithelium after the cauterization therapy, and we keep it under observation with prescribing proton pump inhibitor.