Endoscopic ultrasound-guided ablation of a metastatic hepatogastric lymph node from esophageal cancer using absolute ethanol

A 78-year-old patient, who had a history of endoscopic submucosal dissection (ESD) for early stage esophageal cancer, had been confirmed as having invasive esophageal squamous cell carcinoma 2 years previously ([Fig. 1]). They had declined surgical intervention and instead undergone multiple courses of radiotherapy. Unfortunately, a raised lesion was again detected in the esophagus and treated by endoscopic mucosal resection (EMR) ([Fig. 2]). Histopathologic findings revealed moderately differentiated squamous cell carcinoma with negative margins; however, an abdominal computed tomography (CT) scan identified an enlarged lymph node and positron emission tomography (PET)-CT suggested metastatic involvement in the lymph nodes of the hepatogastric space. Additionally, endoscopic ultrasound (EUS)-guided fine-needle biopsy of the lymph node was performed ([Fig. 3]), which confirmed poorly differentiated squamous cell carcinoma, consistent with metastatic spread from the esophageal primary lesion ([Fig. 4] a).