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Case Reports
. 2017 Aug 7;17(1):94.
doi: 10.1186/s12876-017-0649-y.

A superficial esophageal cancer in an epiphrenic diverticulum treated by endoscopic submucosal dissection

Affiliations
Case Reports

A superficial esophageal cancer in an epiphrenic diverticulum treated by endoscopic submucosal dissection

Kuangi Fu et al. BMC Gastroenterol. .

Abstract

Background: We report a unique case of a superficial esophageal cancer arising in a single diverticulum, diagnosed with magnifying image-enhanced endoscopy and then successfully treated by endoscopic submucosal dissection (ESD).

Case presentation: A 66-year-old man with alcohol-related liver injury visited our hospital for endoscopy for investigation of varix. Esophagogastroduodenoscopy showed no varix but a large epiphrenic diverticulum with an area of fainted redness just above the esophagogastric junction. Narrow band imaging revealed a sharply demarcated brownish dotted area, and dilated intra-epithelial papillary capillary loops (IPCL) were subsequently seen after magnification. Chromoendoscopy with 1% Lugol's iodine solution demonstrated a well-demarcated unstained area, approximately 20 mm in diameter. Endoscopic biopsy revealed a squamous cell carcinoma (SCC).

Conclusion: The tumor was completely resected by ESD without perforation. Histologically, it was an intraepithelial SCC without lympho-vascular invasion of cancer cells. No local recurrence or metastasis was detected at the last follow-up of 42 months.

Keywords: Endoscopic submucosal dissection; Epiphrenic diverticulum; Magnifying endoscopy; Narrow band imaging; Superficial esophageal cancer.

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Conflict of interest statement

Ethics approval and consent to participate

Written consent was obtained from the patient. As a case report, approval from the institutional review board was not needed.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a A large epiphrenic diverticulum just above the esophagogastric junction was seen during esophagogastroduodenoscopy. b An area of fainted redness was detected with white light endoscopy at the bottom of the diverticulum
Fig. 2
Fig. 2
a NBI revealed a demarcated brownish dotted area before magnification. b Dilated intra-epithelial papillary capillary loops (IPCL) were seen after magnifying NBI
Fig. 3
Fig. 3
At the bottom of the diverticulum, chromoendoscopy with 1% Lugol’s iodine solution demonstrated a well-demarcated unstained area, approximately 20 mm in diameter
Fig. 4
Fig. 4
Mucosal defect after ESD was shown and no definite perforation was seen endoscopically
Fig. 5
Fig. 5
White light endoscopy showed no local recurrence 42 months after ESD

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