Barrett’s Esophagus Case Study 4: Barrett’s with Focal Carcinoma-In-Situ

Background

A 78-year-old male ex-smoker with emphysema and a long-standing history of GERD was found on upper endoscopy to have Barrett’s esophagus with a focal area of raised mucosa. A 1 cm nodular lesion was identified along a “tongue” of Barrett’s mucosa. Biopsies from the nodule showed carcinoma-in-situ, and biopsies from neighboring Barrett’s mucosa showed intestinal metaplasia without dysplasia. The patient was referred to a surgeon for transhiatal esophagectomy. Due to the patient’s high surgical risk, endoscopic mucosal resection was recommended.

Treatment

Endoscopic ultrasonography showed preservation of the esophageal wall layers along the length and circumference of the esophagus and focal thickening of the mucosa in the area of the nodule. Mucosectomy was performed, removing a 5 x 3 cm strip of Barrett’s mucosa containing the nodular lesion. Surgical pathology confirmed carcinoma-in-situ with tumor-free margins.

Outcome

On surveillance endoscopy two months later the resected Barrett’s was replaced by normal-appearing squamous epithelium. The remaining Barrett’s mucosa was resected. Surgical pathology showed intestinal metaplasia without malignancy or dysplasia. The patient remains asymptomatic on PPI therapy and free of Barrett’s at one-year follow-up.