Clin Endosc.  2012 Jun;45(2):169-173. 10.5946/ce.2012.45.2.169.

Successful Treatment of Early Gastric Cancer Adjacent to a Fundal Varix by Endoscopic Submucosal Dissection and Endoscopic Cyanoacrylate Therapy

• Kim YS
• Cho WY
• Cho JY
• Jin SY

• KMID: 2048857
• DOI: http://doi.org/10.5946/ce.2012.45.2.169

Abstract

Endoscopic submucosal dissection (ESD) was developed for the en bloc resection of large early gastrointestinal neoplasms. A disadvantage of ESD is its technical difficulty, which requires advanced skills and is associated with a higher rate of complications. Endoscopic variceal obturation (EVO) using cyanoacrylate has emerged as the initial treatment of choice for acute gastric variceal bleeding. This procedure achieves hemostasis in 90% of cases. A 52-year-old patient with Child A alcoholic liver cirrhosis presented with early gastric cancer in the cardia and type 1 isolated gastric varices in the fundus. The two lesions were so close together that treatment was not easy. The lesions were managed successfully with a combination of ESD and EVO using cyanoacrylate.

Keyword

Endoscopic submucosal dissection; Endoscopic variceal obturation; Early gastric cancer; Esophageal and gastric varices

MeSH Terms

Cardia
Child
Cyanoacrylates
Esophageal and Gastric Varices
Gastrointestinal Neoplasms
Hemorrhage
Hemostasis
Humans
Liver Cirrhosis, Alcoholic
Middle Aged
Stomach Neoplasms
Varicose Veins
Cyanoacrylates

Figure

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  Fig. 1 (A) Endoscopic views of the isolated gastric varix. (B) Early gastric cancer adjacent to the varix.

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  Fig. 2 (A) Endoscopic cyanoacrylate therapy of the isolated gastric varix was performed. The picture shows cyanoacrylate with lipiodol filling the varix in fluoroscopic view. (B) On endosonography 2 weeks later, there was no blood flow in the varix.

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  Fig. 3 Endoscopic submucosal dissection of the early gastric cancer (EGC) showing the EGC and treated varix before (A) endoscopic submucosal dissection, (B) the incision with muscle exposure, (C) the incision above the varix, and (D) a large artificial ulcer after the resection.

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  Fig. 4 (A) Pathologic mapping of the specimen shows the tumor in the center of the specimen. The tumor was completely resected with free lateral and vertical margins. The orange area depicts the area where the tumor invaded no further than the mucosal layer and the purple area show the area of submucosal invasion. (B) Microscopic findings revealed adenocarcinoma with minimal submcosal invasion, to a depth of 150 µm (H&E stain, ×100).

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  Fig. 5 Follow-up endoscopic view shows that the ulcer has healed 2 months after the endoscopic submucosal dissection.

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