A CASE OF BARRETT ESOPHAGUS TREATED BY ESOPHAGEAL BLUNT DISSECTION WITHOUT THORACTOMY

Abstract

A case of Barrett esophagus is presented. A 71-year-old man was first admitted to our hospital because of dysphagia. Two years before admission, he had complained of heartburn and epigastric pain. Endoscopy showed a hiatus hernia and gastric mucosa in the lower esophagus. Mucosal biopsy specimens revealed columnar epithelium extending upward, with no malignancy. Diagnosis of Barrett esophagus was made. He began receiving cimetidine, 800 mg/day, orally. Although the symptoms were relieved after the medical regimen, serial endoscopy showed no marked improvement but occasional ulcer formation in the columnar epithelial zone during these two years. On this admission, physical examination revealed an undernourished man in no acute distress. Laboratory studies disclosed mild anemia and mild restrictive pattern on pulmonary function test. Chest X-ray showed an old focus of tuberculosis and diffuse pleural calcification of the right lung. Upper GI series demonstrated stricutre of the lower esophagus without ulcer formation. With pulmonary complications taken into account, blunt esophageal dissection was performed without thoracotomy. The postoperative course was uneventful and the patient was discharged 40 days after surgery. Clinicopathological aspects of Barrett esophagus and its malignant potential are discussed. Blunt esophageal dissection without thoracotomy is considered a preferred treatment of choice.