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Barrett’s Esophagus Case Study 1: Intestinal Metaplasia
Background:
A 62-year-old male presented with complaints of daily heartburn and chest discomfort. These symptoms had been ongoing for seven to eight years but had worsened over the last few months. He underwent an upper endoscopy and Barrett’s esophagus was diagnosed. A nodular area was noted in the lower esophagus and biopsies of this showed high-grade dysplasia. Biopsies of the areas surrounding the nodule showed intestinal metaplasia. He was subsequently referred to IESMG for evaluation and treatment.
Treatment
Endoscopic examination demonstrated a short segment of Barrett’s esophagus with a nodular area at the gastro-esophageal junction. Optical zoom endoscopy was used to accurately define the areas with suspected dysplasia. Endoscopic mucosal resection (EMR) or mucosectomy was performed allowing successful removal of the abnormal appearing mucosa.
Outcome
The pathology from the EMR specimen confirmed high-grade dysplasia in Barrett’s esophagus. Endoscopy two months later revealed a well-healed scar at the resection site. The patient is doing well without further evidence of dysplasia on surveillance endoscopy.
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- Zoom endoscopy combined with Narrow Band Imaging (NBI) of the nodular area (yellow circle). Note the raised mucosa, aberrant crypts and corkscrew vessels suggestive of dysplasia
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- The nodular area has been successfully removed using minimally invasive endoscopic techniques (yellow arrow).
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- Endoscopic examination two months post treatment using Narrow Band Imaging (NBI) showing well-healed scar at the resection site (yellow arrow). No evidence of residual Barrett’s is seen.
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