Endoscopic therapy in patients with Barrett's esophagus and portal hypertension

BackgroundEndoscopic mucosal resection has been used to stage and treat early neoplasia in Barrett's esophagus. The ability to do this in the setting of portal hypertension has not been reported.ObjectiveOur purpose was to describe the feasibility and efficacy of endoscopic mucosal resection in patients with portal hypertension and Barrett's esophagus.DesignRetrospective case series.SettingTwo tertiary referral centers.PatientsPatients with Barrett's esophagus and high-grade dysplasia or adenocarcinoma in the setting of portal hypertension.InterventionEndoscopic mucosal resection of endoscopically visible lesions.Main Outcome MeasurementsComplete resection of neoplastic lesion, lack of variceal bleeding.ResultsFour patients were treated with endoscopic mucosal resection a total of 5 times. Endoscopic mucosal resection was successfully performed without significant GI bleeding.LimitationsThis preliminary case series describes feasibility of the procedure. Whether this can be generalized remains to be determined, although it may be an option in poor surgical candidates.ConclusionsEndoscopic mucosal resection appears to be relatively safe in selected patients with portal hypertension and Barrett's esophagus. Further studies are needed to confirm these findings.