Endoscopic Submucosal Dissection for Esophageal Adenocarcinoma Amidst Variceal Vulnerability

Endoscopic submucosal dissection (ESD) has become a curative therapy for early esophageal adenocarcinoma (EAC), yet the presence of esophageal varices poses significant challenges. We present the case of a 67-year-old man with alcoholic cirrhosis and varices who was found to have a short-segment Barrett's esophagus containing a mass at the gastroesophageal junction. Subsequent biopsy confirmed intramucosal adenocarcinoma of the esophagus. Given the patient's poor surgical candidacy, ESD was performed. This case illustrates that carefully planned ESD can be safely executed in select patients with EAC and esophageal varices when standard therapy is contraindicated. It also highlights the possibility of high-risk malignancy even in short-segment Barrett's esophagus.