Multiple Early Carcinomas of the Esophagus Associated with Achalasia Treated by Endoscopic Submucosal Dissection

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We report a case of early esophageal carcinomas associated with achalasia treated by endoscopic submucosal dissection. A 46-year-old man was diagnosed of esophageal achalasia, flask type and Grade II in 2001, and had been treated by pneumatic dilatation for symptomatic achalasia conservatively. The patient was operated by Tokai University method, Heller's long esophagomyectomy, Hill's posterior cardiopexy, fundoplication and selective proximal vagotomy using a laparotomy in August 2009. One year and three months after the operation, two lesions of early carcinomas of type 0-IIb and 0-IIc, each 1cm in size, were detected in the middle thoracic esophagus, and treated by endoscopic submucosal dissection. Pathological examination of the each lesion revealed proliferation of squamous cell carcinoma in situ (T1a-EP). The entire esophageal mucosa around the carcinoma demonstrated hyperplastic changes of stratified squamous epithelium and foci of intraepithelial neoplasia. In the patient of achalasia, food stasis in esophagus is thought to induce chronic hyperplastic esophagitis, converting eventually to malignant transformation. Achalasia is known as a risk factor of esophageal squamous cell carcinoma. Careful long-term follow-up for patients of achalasia by endoscopic screening is recommended, even if after treatment by pneumatic dilatation or operation for achalasia.
日本癌病態治療研究会の論文