A male in his 80s was diagnosed with reflux esophagitis and Barrett's esophagus, and underwent endoscopy annually. After treatment for chronic pharyngeal mycosis, he developed scar stenosis at the esophageal orifice and regular follow-up was performed with a small-caliber endoscope. A depressed lesion was found in the esophagogastric junction (EGJ), and biopsy examination revealed adenocarcinoma (tub1). The preoperative diagnosis was Barrett's esophageal adenocarcinoma (depth, DMM-SM1). After endoscopic balloon dilatation, a therapeutic endoscope could be inserted and endoscopic submucosal dissection (ESD) was performed. Pathological examination revealed poorly differentiated adenocarcinoma, pT1b-SM2, ly1, v1, pHM0, pVM0. He desired no additional surgery. Five months later, lymph node and distant metastases developed.
Using a small small-caliber endoscope requires more careful observation for early detection of Barrett's esophageal adenocarcinoma because of its limited maneuverability compared to with that of the standard endoscope.
