An early-stage adenocarcinoma originating from a 15-cm long-segment Barrett’s esophagus: A case report

Rationale: Barrett’s esophagus (BE), a precancerous lesion for esophageal adenocarcinoma, is classified into short-segment and long-segment types, with the latter being less common. This report describes a rare case of early-stage adenocarcinoma originating from a long-segment BE, approximately 15 cm from the gastro-esophageal junction. Patient concerns: A 68-year-old male presented with intermittent acid reflux and heartburn for over 30 years, which had worsened over the past month, accompanied by discomfort during eating. Gastroscopy identified a flat lesion measuring approximately 1.5 cm × 1.0 cm, located 30 cm from the incisors. Pathological examination suggested high-grade adenomatous dysplasia with possible carcinoma. Diagnoses: Long-segment BE; flat-type esophageal lesion (0-IIb + 0-IIc) with high-grade adenomatous dysplasia and focal well-differentiated adenocarcinoma, suspected to invade the muscularis mucosae layer. Interventions: Following preoperative evaluation, the endoscopic submucosal dissection procedure was successfully performed under general anesthesia, The preoperative diagnosis and postoperative surveillance of this patient also incorporated the use of a cytosponge™ device and confocal laser endomicroscopy. Outcomes: The patient remained free of tumor recurrence or metastasis during subsequent follow-up visits. Lessons: Endoscopic submucosal dissection is an effective treatment for early-stage esophageal adenocarcinoma, early detection and treatment are key to improving survival, cytosponge™ device helps to detect high-risk groups. Confocal laser endomicroscopy represents an advanced endoscopic imaging modality that facilitates preoperative diagnosis and postoperative surveillance in early-stage esophageal carcinoma.