Pan-esophageal squamous papillomatosis with high grade dysplasia managed with endoscopic submucosal dissection

A 63-year-old woman presented to her local gastroenterologist with a two-year history of dysphagia. A barium swallow demonstrated free passage of liquid barium and a barium-soaked marshmallow but noted a small irregularity of the mucosal surface in the mid esophagus ([Fig. 1]). Subsequent gastroscopy revealed circumferential diffuse white-pink plaques with a cobblestone appearance, extending 23–38 cm from the incisors. Biopsies revealed squamous papillomatosis with multifocal low and high grade dysplasia. Computed tomography of the neck, chest, and abdomen was unremarkable. She was referred for consideration of endoscopic submucosal dissection (ESD).