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

Background: Endoscopic 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. Objective: Our purpose was to describe the feasibility and efficacy of endoscopic mucosal resection in patients with portal hypertension and Barrett's esophagus. Design: Retrospective case series. Setting: Two tertiary referral centers. Patients: Patients with Barrett's esophagus and high-grade dysplasia or adenocarcinoma in the setting of portal hypertension. Intervention: Endoscopic mucosal resection of endoscopically visible lesions. Main Outcome Measurements: Complete resection of neoplastic lesion, lack of variceal bleeding. Results: Four patients were treated with endoscopic mucosal resection a total of 5 times. Endoscopic mucosal resection was successfully performed without significant GI bleeding. Limitations: This 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. Conclusions: Endoscopic 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.