An early-stage adenocarcinoma originating from a 15-cm long-segment Barrett's esophagus: A case report

Barrett's esophagus (BE), a precancerous lesion for esophageal adenocarcinoma, is classified into short-segment and long-segment types, with the latter being less common. This report describes a rare case of early-stage adenocarcinoma originating from a long-segment BE, approximately 15 cm from the gastro-esophageal junction.

A 68-year-old male presented with intermittent acid reflux and heartburn for over 30 years, which had worsened over the past month, accompanied by discomfort during eating. Gastroscopy identified a flat lesion measuring approximately 1.5 cm × 1.0 cm, located 30 cm from the incisors. Pathological examination suggested high-grade adenomatous dysplasia with possible carcinoma.

Long-segment BE; flat-type esophageal lesion (0-IIb + 0-IIc) with high-grade adenomatous dysplasia and focal well-differentiated adenocarcinoma, suspected to invade the muscularis mucosae layer.

Following preoperative evaluation, the endoscopic submucosal dissection procedure was successfully performed under general anesthesia, The preoperative diagnosis and postoperative surveillance of this patient also incorporated the use of a cytosponge™ device and confocal laser endomicroscopy.

The patient remained free of tumor recurrence or metastasis during subsequent follow-up visits.

Endoscopic submucosal dissection is an effective treatment for early-stage esophageal adenocarcinoma, early detection and treatment are key to improving survival, cytosponge™ device helps to detect high-risk groups. Confocal laser endomicroscopy represents an advanced endoscopic imaging modality that facilitates preoperative diagnosis and postoperative surveillance in early-stage esophageal carcinoma.