2017 Volume 90 Issue 1 Pages 80-81
A 66-year-old woman was hospitalized with alcoholic liver cirrhosis classified as Child-Pugh A. Esophagogastroduodenoscopy revealed three columns of esophageal varices (LmF1CbRC (-) Lg-C (+) ) and a superficial depressed lesion of 15 mm in diameter located about 30cm from the incisors as a brownish area by NBI (narrow band imaging) . Magnifying endoscopy with NBI showed many inhomogeneous loop-like vessels varying in caliber with small avascular areas (B1 vessels with AVA-small) in the lesion. The lesion was unstained by Lugol’s solution. It was, therefore, diagnosed as an early esophageal carcinoma of depth EP/LPM and endoscopic submucosal dissection (ESD) was indicated. Due to the risk of bleeding from the varices near the lesion during the procedure, the varices were treated by endoscopic variceal ligation before ESD. After confirming the disappearance of the varices, ESD was performed by the double channel method with EEMR-tube without complications such as active bleeding. Pathologically, the tumor was diagnosed as squamous cell carcinoma, 0-IIc, pT1a-EP, ly0, v0, pHM0, pVM0. Pretreatment of EVL may be useful for avoiding the risk of active bleeding during ESD for superficial esophageal cancer near esophageal varices.
