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Most patients with cirrhosis and portal hypertension eventually require liver transplantation. Esophageal neoplasia in this population (especially in patients who use alcohol and tobacco) might contraindicate liver transplantation. Early Barrett’s neoplasia should be treated with endoscopic resection if there are no signs of advanced adenocarcinoma, and complete eradication of all remaining Barrett’s epithelium should be striven for, preferably with radiofrequency ablation (RFA) [1]. However, these treatments may become challenging in patients with portal hypertension and esophageal varices, due to the risk of variceal bleeding and hepatic decompensation. Some reports have been published of endoscopic resection after a session of endoscopic variceal ligation, but without RFA for eradication therapy [2, 3]. We present a case series of three patients with esophageal varices and Barrett’s neoplasia successfully treated with a modified endoscopic resection technique and RFA (▶Table 1). E-Videos

endoscopy

Eradication of neoplastic Barrett’s esophagus in patients with esophageal varices with a modified endoscopic mucosal resection technique and radiofrequency ablation