The patient was a 60-year-old man with alcoholic liver cirrhosis. Esophagogastroduodenoscopy performed for upper gastrointestinal bleeding revealed a superficial depressed lesion close to esophageal varices, about 35-37 cm from the incisors. Biopsy of the lesion revealed squamous cell carcinoma. Magnifying endoscopy with NBI (narrow band imaging) showed many inhomogeneous loop-like vessels varying in caliber within the lesion, and the tumor was found to invade the lamina propria mucosa.
ESD (endoscopic submucosal dissection) was performed after EVL (endoscopic variceal ligation) of the esophageal varices. EVL carried out 2 cm away from the lesion did not cause fibrosis of the submucosa under the tumor. En-bloc resection was achieved without any complications. Histopathologically, the tumor was diagnosed as squamous cell carcinoma, pT1a-LPM, ly0, v0, pHM0, pVM0.
ESD following EVL could be a useful therapeutic strategy for superficial esophageal carcinomas associated with esophageal varices.
