ENDOSCOPIC MUCOSAL RESECTION IN DYSPLASTIC BARRETT'S OESOPHAGUS WITH UNDERLYING OESOPHAGEAL VARICES USING BAND LIGATION

Introduction:

Dysplastic Barrett's oesophagus (BE) is usually treated by techniques such as endoscopic mucosal resection (EMR) and radiofrequency ablation.

Resection procedures to remove visible lesions is recommended for adequate histological analysis. Nevertheless this treatment may become challenging in patients with liver cirrhosis and portal hypertension with oesophageal varices (EV).

Aims:

To perform an endoscopic resection of visible lesions in patients with dysplastic Barrett's oesophagus and underlying oesophageal varices.

Methods:

Patients with dysplastic BE and underlying EVs confirmed by endoscopic ultrasound were schedule for the modified EMR.

EMR was performed under deep sedation by an experienced endoscopist in endoscopic resection techniques using a (band) ligation-assisted EMR device. Somatostatin and prophylactic antibiotics were administered for 24 hours starting immediately before the procedure.

Prior to the resection, the target lesion was identified and band ligation was applied to the distal part of the closest EV to cut the blood flow income from distal to proximal. Then the target lesion was resected using conventional ligation-assisted EMR.

Results:

EMR was performed in three patients with compensated cirrhosis and BE with prior histology of confirmed high grade dysplasia.

There were no cases of clinically relevant intraprocedural bleeding. All patients were discharged after 24 hours of the procedure. There was only one case of delayed bleeding 8 days after the procedure, that did not require endoscopic treatment.

The EMR specimens showed high grade dysplasia in one case and intramucosal adenocarcinoma in two cases.

Conclusions:

EMR in cases of BE in patients with EVs is feasible, allowing an appropriate histological diagnosis to direct the management.

The use of band ligation to decrease the blood flow might be convenient in these cases.