Barrett’s Esophagus and Esophageal Squamous Cell Neoplasm Evaluation: Multimodality Treatment and Surveillance

Barrett’s esophagus/superficial esophageal adenocarcinoma and squamous cell superficial cancer, and multi-modality management by endoscopic eradication therapy individualized to patients that include a single or combined treatment strategy.

EMR:

Case 1:

2 cm segment of Barrett’s esophagus with nodule and abnormal surface pattern. Cap assisted EMR to top of the gastric fold. En bloc resection. Pathology revealed multifocal HGD/intramucosal cancer. Deep and lateral margins were clear.

Case 2:

A laterally spreading 3 cm segment of Barrett’s esophagus with previous biopsy-proven multifocal HGD. Cap assisted EMR as overlapping wide field resection.

RFA with Barrx™ ablation devices:

Case 1:

A hemi-circumferential segment of long-segment Barrett’s esophagus with multifocal HGD and LGD. Treatment with Barrx™ Halo Ultra 90 RFA.

Case 2:

Long segment circumferential Barrett’s with multifocal HGD and LGD. Treatment with Barrx™ Halo 360 balloon RFA.

Case 3:

Residual non-dysplastic Barrett’s managed with adjunct Hybrid-APC ablation after endoscopic resection of nodule in Barrett’s with high grade dysplasia.

ESD:

Intra mucosal cancer at GE junction extending onto Cardia within recurrent Barrett’s esophagus after prior RFA. White Light Endoscopy, NBI, and post-resection base.

Mid-Esophageal Squamous Cell Superficial Cancer Chromoendoscopy and EMR

This is a case of an 82-year male with incidental finding of aberrant mucosa during diagnostic EGD for indigestion/reflux-related symptoms. Biopsies reported “severe” dysplasia on the limited specimen. Given concern for at least HGD or possible early squamous cell carcinoma, he was referred for further evaluation. Detailed endoscopic evaluation was performed with NBI and near focus in addition to chromoendoscopy with Lugol’s iodine, further defining and demarcating the dysplastic lesion as a flat granular lesion and focal superficial ulceration from the prior biopsy site. Given significant esophageal spasm with limited visualization, instead of ESD, Cap-assisted EMR was meticulously performed in a contiguous fashion in two pieces sequentially. Final pathology revealed multifocal HGD (superficial T1a cancer) with clear deep and lateral margins on both specimens when oriented for prior pre-marking.

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