title: Endoscopic therapy in patients with Barrett's esophagus and portal hypertension.
abstract: BACKGROUND
  Endoscopic mucosal resection has been used to stage and treat early neoplasia in Barrett's esophagus. The ability to do this in the setting of portal hypertension has not been reported.
  
  
  OBJECTIVE
  Our purpose was to describe the feasibility and efficacy of endoscopic mucosal resection in patients with portal hypertension and Barrett's esophagus.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Two tertiary referral centers.
  
  
  METHODS
  Patients with Barrett's esophagus and high-grade dysplasia or adenocarcinoma in the setting of portal hypertension.
  
  
  METHODS
  Endoscopic mucosal resection of endoscopically visible lesions.
  
  
  METHODS
  Complete resection of neoplastic lesion, lack of variceal bleeding.
  
  
  RESULTS
  Four patients were treated with endoscopic mucosal resection a total of 5 times. Endoscopic mucosal resection was successfully performed without significant GI bleeding.
  
  
  CONCLUSIONS
  This preliminary case series describes feasibility of the procedure. Whether this can be generalized remains to be determined, although it may be an option in poor surgical candidates.
  
  
  CONCLUSIONS
  Endoscopic mucosal resection appears to be relatively safe in selected patients with portal hypertension and Barrett's esophagus. Further studies are needed to confirm these findings.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
authors.forename: Ganapathy A
authors.initials: GA
authors.lastname: Prasad
authors.forename: Kenneth K
authors.initials: KK
authors.lastname: Wang
authors.forename: Ann M
authors.initials: AM
authors.lastname: Joyce
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kochman
authors.forename: Lori S
authors.initials: LS
authors.lastname: Lutzke
authors.forename: Lynn S
authors.initials: LS
authors.lastname: Borkenhagen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001471:Barrett Esophagus / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications* / Q000503:physiopathology; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies