Squamous Subepithelial Spread of Superficial Barrett's Esophageal Carcinoma Dai Hirasawa 1,2 , Taku Yamagata 3 , Yuki Maeda 3 , Yoshihiro Harada 3 , Tetsuya Ohira 3 , Kenjirou Suzuki 3 , Yoshiki Koike 3 , Yasuhiro Shimada 3 1Digestive Endoscopic Center, Sendai Kousei Hospital, Sendai, Japan 3Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan Keyword: 酢酸撒布 , small white sign(SWS) , rising gland , Barrett食道癌 , 範囲診断 pp.1334-1343
Published Date 2016/9/25
DOI https://doi.org/10.11477/mf.1403200729
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 Barrett's esophageal adenocarcinoma occasionally spreads laterally under healthy squamous epithelium, and this condition is termed BCUS(Barrett's cancer under the squamous epithelium). As cancerous cells are not present in the superficial layer in such cases, it is difficult to determine the extent by endoscopy. Endoscopic findings of BCUS include light redness on white light imaging and light brown changes on narrow band imaging. However, such findings can sometimes be insufficient to make a diagnosis. Spraying with 1.5% acetic acid enables the observation of light white changes(small white sign ; SWS)that were not previously confirmed visually in BCUS. Histopathology reveals the openings of cancerous glands into the superficial layer under the squamous epithelium(rising gland)in the area consistent with those obtained by acetic acid spraying. This thesis explains SWS, which are endoscopic findings characteristic of the area in which Barrett's adenocarcinoma spreads under the squamous epithelium, based on the report of a case that we treated.

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