SUCCESSFUL COMPLETE ERADICATION OF BARRETT'S ADENOCARCINOMA WITH UNDERLYING ESOPHAGEAL VARICES WITH MODIFIED EMR TECHNIQUE AND RADIOFREQUENCY ABLATION

Case:

We present the case of a 63-year-old patient with alcohol liver cirrhosis, with portal hypertension and esophageal varices in prophylaxis with beta-blocker.

During follow-up upper endoscopy a 0-IIa lesion is detected on a barrett's esophagus.

A modified band ligation EMR technique was performed, with histology showing intramucosal adenocarcinoma, clear margins.

Three sessions of radiofrequency ablation with HALO 360 and 90 of the remaining Barrett's esophagus were performed with the standard technique. In each session, intravenous somatostatin was administered starting before the procedure, and maintaining it 24 hours. Prophylactic antibiotic was administered peri-procedure. After each session hospital discharge was performed at 24 hours, there were no incidents or complications during or after the procedure.

In the last follow-up endoscopy Barrett erradication was confirmed endoscopically and histologically.

Comments:

Radiofrequency (HALO) ablation can be performed in selected cases of patients with esophageal varices and dysplastic Barrett, taking into account the risks and benefits of the technique.

In the present case Barrett's esophagus (T1a) in a cirrhotic patient with esophageal varices, was successfully eradicated following radio frequency ablation (HALO), without complications.