Endoscopic resection of Barrett's early carcinoma with a ligation device

This is a case of a 64-year-old patient with long standing reflux disease. At an upper endoscopy, a circumscribed early Barrett’s neoplasia was detected. Subsequent endosonography did not show any involvement of lymph nodes.
Here, an endoscopic resection of the Barrett’s neoplasia with a ligation device is performed.
In this case, the final histological diagnosis of the specimen was a moderately differentiated neoplasia extending to the edge of the submucosa without any lymph vessel invasion. Therefore, the endoscopic resection is regarded to be curative in this case.

Take home messages:

Indeed, endoscopic resection is the treatment of choice for most early Barrett’s neoplasias that do not invade deeper than the upper layer of the submucosa.

Some neoplasias are very subtle and hard to demarcate and in these cases auxiliary techniques like chromoendoscopy are highly recommended, in particular chromoendoscopy with acitic acid as it highlights the mucosal details of both, the non-neoplastic and the neoplastic mucosa.

For prediction of local infiltration depth macroscopic evaluation is superior to endosonography.

However, before proceeding to endoscopic resection a complete staging of the tumor is mandatory. This certainly includes endosonographic evaluation of a possible lymph node involvement.