Background : Identification of the margin is important for the diagnosis and treatment of early gastrointestinal (GI) cancer. However, it is sometimes difficult in Barrett esophageal cancer. We report a case which was able to accurate demarcation of the area.
Case : A 59 years old man received an upper GI endoscopy for follow-up of reflux esophagitis. Reddish granular change was found in posterior wall of esophagogastric junction, and biopsy of this lesion revealed adenocarcinoma. Based on the clinical diagnosis of type 0-IIc＋IIa intra-mucosal cancer arising from short-segment Barrett’s esophagus, ESD was performed. Although the proximal margin was unclear with influence of inflammation, recognizing mucosal thickness and microvascular network pattern is useful to diagnose demarcation line. At distal margin, demarcation line was difficult to recognize because of unnatural depressed line under SCJ considered to be caused by exfoliation of covering squamous epithelium above the cardiac gland. Pathological finding was identical with pre-operative endoscopic diagnosis of the cancer margin.
Conclusion : Approach from certificate endoscopic findings is important, especially in case of superficial Barrett esophageal cancer which is difficult to identify cancer margin.
