Endoscopic submucosal dissection for early esophageal squamous cell carcinoma with esophageal-gastric fundal varices caused by liver cirrhosis: a case report

Background: There is limited reporting of treatment options for early esophageal squamous cell carcinoma in esophageal-gastric fundal varices patients. Historically, surgery is the preferred treatment for squamous cell carcinoma; however, esophagectomy is associated with higher complications and death rates. The difficulty of such an operation was the varicose veins around the mucosa of the lesion. Possibility of concomitant intraoperative fatal bleeding. Previous studies have proved the effectiveness of endoscopic mucosal resection (EMR) paired with endoscopic injection sclerotherapy (EIS) for treating early esophageal cancers on esophageal varices. Case Description: We reported an effective endoscopic treatment of such conditions in a 62-year-old man with liver cirrhosis. After seeking informed consent, we performed endoscopic submucosal dissection (ESD) of early esophageal squamous cell carcinoma after the eradication of esophageal-gastric fundal varices using EIS. The resection margins indicated negative for carcinoma and dysplasia, suggesting that no recurrence and complication occurred. The patient was discharged 5 days after ESD without any complications including perforation or bleeding. No complaint from the patient was received during the 1-week follow-up, and the patient was tolerating solid food. The pathological result of the two lesions both showed moderately differentiated squamous cell carcinoma of the esophagus, T1bN0M0. The resection margins suggested negative for both carcinoma and dysplasia according to pathological examination. There was no recurrence or adverse event during follow-up. Conclusions: Our case presented the successful treatment of esophageal squamous cell carcinoma on esophageal-gastric fundal varices. This indicated that patients with cirrhosis and portal hypertension could also be treated with ESD, which could reduce trauma and discomfort and improve their quality of life. We recommend future studies to further investigate the indications of using endoscopic treatment for patients with cirrhosis.