Barrett’s Esophagus Case Study 5: Barrett’s with Multifocal High-Grade Dysplasia

Background

A 63-year-old male with chronic GERD was diagnosed to have circumferential Barrett’s involving a 4 to 5 cm segment of the distal esophagus. Biopsies showed high-grade dysplasia, confirmed by a second pathologist. Biopsies obtained two years earlier showed intestinal metaplasia without dysplasia. He was referred to the Interventional Endoscopy Services Medical Group for mucosectomy.

Treatment

Enhanced magnification endoscopy showed typical Barrett’s esophagus with patchy areas of aberrant mucosa consistent with high-grade dysplasia. EUS showed well-preserved wall layers and diffuse mucosal thickening. One-half of the circumference of Barrett’s esophagus was resected using piecemeal mucosectomy technique. Surgical pathology showed Barrett’s metaplasia with foci of low- and high-grade dysplasia.

Outcome

Follow-up endoscopy, six weeks later, showed the resected Barrett’s mucosa was well healed, replaced by squamous epithelium. Mucosectomy of the remaining hemicircumference of his Barrett’s esophagus was performed. Low- and high-grade dysplasia was seen without malignancy was again found.