Endoscopic submucosal dissection for Barrett's-associated adenocarcinoma in a patient with decompensated cirrhosis and esophageal varices.

Abstract

Presently, endoscopic resection is the preferred treatment of choice for patients with Barrett’s dysplasia, especially high-grade dysplasia and even early esophageal adenocarcinoma.1 However, among the various endoscopic resection techniques, endoscopic submucosal dissection (ESD) may carry a higher risk of adverse events in patients with cirrhosis because of the low platelet count, coagulopathy, and presence of esophageal varices.2,3 To date, only small case series of esophageal ESDs, especially for squamous cell carcinoma, have been reported from Asia in patients with cirrhosis, but the included patients were well compensated, with platelet counts >50 k/μL.