Esophageal Dissection After Transesophageal Echocardiography in a Patient With Barrett's Esophagus and Long-term Systemic Steroid Therapy

Abstract

BARRETT’S ESOPHAGUS is a condition in which an intestinal-type epithelium called specialized intestinal metaplasia or Barrett’s metaplasia replaces the stratified squamous epithelium that normally lines the distal esophagus.1 Barrett’s esophagus develops as a consequence of chronic gastroesophageal reflux disease and predisposes to the development of adenocarcinoma of the esophagus.1 Barrett’s esophagus is usually discovered during endoscopic examinations in middle-aged and older adults whose mean age at the time of diagnosis is approximately 55 years.1 Although arrett’s esophagus can affect children, it rarely occurs before he age of 5 years.2 This observation supports the hypothesis hat a Barrett’s esophagus is an acquired condition in the vast ajority of patients. The male-to-female ratio is approximately :1.3 The columnar metaplasia of a Barrett’s esophagus causes no symptoms. Most patients are seen initially for symptoms of the associated gastroesophageal reflux disease such as heartburn, regurgitation, and dysphagia. Estimates of the frequency of Barrett’s esophagus in the general population have varied widely, ranging from 0.9% to 4.5% depending in part on the population studied and the definitions used.4,5 The overall reiability of endoscopy with a biopsy for the detection of Barett’s esophagus is approximately 80%.6 A case of esophageal issection after transesophageal echocardiography (TEE) perormed during mitral valve repair in a patient whose past edical history was positive for Barrett’s esophagus is preented.