Talley: Practical Gastroenterology and Hepatology Board Review Toolkit

Practical Gastroenterology and Hepatology Board Review Toolkit

Nicholas J. Talley , Kenneth R. Devault, Michael B. Wallace, Bashar A. Aqel, Keith D. Lindor


23.3 Endoscopic mucosal resection of early adenocarcinoma in short-segment Barrett esophagus.

Case 1: White-light endoscopy showed an elevated lesion with an excavation on the surface approximately 2 cm in diameter at the lesser curvature of the incisura. Chromoendoscopy with indigocarmine highlighted the excavation as a puddle of indigocarmine. Endoscopic ultrasound with a 20 MHz miniature probe demonstrated a hypoechoic lesion that invaded into the submucosal layer, although evaluation of the center of the lesion was difficult due to artifacts associated with ulceration. The patient was surgically treated with distal subtotal gastrectomy. Then, the targeted diseased mucosa was circumferentially marginated from the surrounding normal mucosa and freed from the muscularis propria by electrosurgical dissection using one of the many specialized needle knives, a tip-insulated needle knife.

Case 2: White-light endoscopy showed a polypoid lesion approximately 3 cm in diameter at the anterior wall of the upper body. Chromoendoscopy with indigocarmine clearly highlighted surface mucosal structures. Also, magnification endoscopy enhanced with narrow-band image, which is an enhanced endoscopic imaging technology to highlight superficial vascular structures and to reveal the irregular capillary network of a malignant region as brownish lines on the surface. Endoscopic ultrasound with a 20 MHz miniature probe revealed that the polypoid lesion had a stalk and the tumor was restricted within the head of the pedunculated lesion without invasion into the stalk and the deeper layers. The lesion was endoscopically excised.