4th Year Advanced Endoscopy Fellows Program | October 2021-Bhatt

Bhatt_Endoscopic Luminal Case

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This document discusses a case of esophageal adenocarcinoma in a 79-year-old male that was incidentally diagnosed during an evaluation for a persistent cough. The case involves multiple lesions, including a distal esophageal mass and a lesion at the gastric cardia. The staging of the cancer is determined to be T1b N0 based on previous imaging.<br /><br />The document explores the principles of endoscopic resection for esophageal adenocarcinoma, emphasizing the difference between endoscopic and surgical resection and the absence of lymph node dissection in endoscopic resection. It also discusses the risk of lymph node metastasis at various stages of the cancer.<br /><br />The risks of esophagectomy, including mortality and morbidity, are also mentioned. The guidelines for endoscopic submucosal dissection (ESD) in esophageal neoplasia are outlined, with specific indications for superficial visible lesions and lesions at risk for submucosal invasion.<br /><br />In the case presented, ESD resection of the tumors was performed as the patient was deemed a poor candidate for surgery. The accuracy of EUS staging and the use of ESD for further treatment based on results are discussed.<br /><br />The document also briefly mentions a specific surgical technique, C Shape Incision - IT Tunneling Technique, for esophageal ESD.<br /><br />The pathology of the resected tumors is described, indicating T1a stage and the presence of poorly differentiated cancer in two foci. The importance of assessing lymphovascular invasion (LVI) and obtaining clear margins in the resection is mentioned.<br /><br />The next steps in the treatment plan are discussed, including adjuvant radiation therapy based on the risk areas around the tumor bed and the regional lymph nodes. Additionally, the document highlights the importance of RFA ablation of any residual Barrett's esophagus (BE) to prevent metachronous cancer.<br /><br />Overall, the document provides an overview of a case of esophageal adenocarcinoma and discusses the principles of endoscopic resection, staging, treatment options, and the importance of comprehensive management including ablation of residual BE.

Keywords

esophageal adenocarcinoma

79-year-old male

endoscopic resection

lymph node metastasis

esophagectomy

ESD

pathology

adjuvant radiation therapy

clear margins

Barrett's esophagus