Five cases of Barrett′s cancer resected by ESD

Abstract

The incidence of Barrett′s cancer has been increasing recently, and there are case reports of its resection by ESD. Here, we report five further cases of Barrett′s cancer removed by ESD between March 2005 and December 2008.
All cases were men mean age 60 years (range 50-74) . Endoscopic macroscopic type was 0-IIa in three patients, 0-IIc in two. All cases originated from SSBE and were well-differentiated adenocarcinomas, four mucosal and one submucosal. The latter required surgical treatment after ESD. Average tumor size was 21mm (11-38mm) . The procedure was as follows : marking by APC, submucosal injection with glyceol or hyaluronic acid, and dissection using an IT knife (R) . We recognized demarcation lines using conventional endoscopy in all cases ; one case had a positive horizontal margin because of cancer invasion under the squamous epithelium which was not diagnosed before ESD. There were no complications in these five cases.
It is estimated that Barrett′s cancer will continue to increase. ESD can be appropriate for diagnosis and treatment of Barrett′s cancer, but difficulty in recognizing the demarcation line has been reported. In our cohort, we did experience a problem with preoperative evaluation missing cancer invasion under the squamous epithelium. [ESD : endoscopic submucosal dissection, SSBE : short segment Barrett epithelium]