1827 Concurrent Barret’s Esophagus and Esophageal Varix With Resolution After Banding

Abstract

INTRODUCTION: Barret’s esophagus with dysplasia is a premalignant condition frequently treated with radiofrequency ablation. However, the management of concurrent dysplasia with esophageal varices (EV) is not defined. Medical literature on this topic is scant and consists of a few case reports. The following is a case of Barret's esophagus with low grade dysplasia and concurrent esophageal varices, successfully treated with band ligation. CASE DESCRIPTION/METHODS: The patient is a 50-year-old man with a history of liver cirrhosis, who presented to our gastroenterology clinic for routine evaluation. His only complaint was chronic heartburn. EGD was significant for grade I esophageal varices and a small segment of columnar epithelium on a variceal segment. Biopsy results were positive for BE with low grade dysplasia. The patient was started on a proton pump inhibitor and scheduled for follow-up. Patient was placed under surveillance with annual EGD. Frequent discussions were held regarding the risks vs benefits of the different treatment options. Next endoscopy revealed progression of his EV to grade II and a persistent area of columnar epithelium on one of the varices. A decision was made to band 2 varices, including the one with Barrett’s epithelium. Repeat endoscopy one year later demonstrated complete resolution of both, the varix and the columnar epithelium. Biopsy was negative for dysplasia and metaplasia. Ten years later, with yearly follow-up, endoscopy continues to be unremarkable in the banded segment. DISCUSSION: Epidemiology of BE and its relationship with adenocarcinoma has been extensively described in literature, however it is unknown what percentage of these patients have underlying liver cirrhosis with complications such as EV. This maybe be due to decreased life expectancy of these patients and the lack of routine endoscopic screening.We expect to face more of these challenging cases due to improved life expectancy of cirrhotic patients and the more readily available screening, such as endoscopic procedures for esophageal varices. Our case presents a novel method of treating this unique and difficult clinical scenario. However, we need more cases to validate our work.