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intraepithelial neoplasia of the head and neck in a patient after surgical resection of esophageal cancer Patients with esophageal squamous cell carcinoma (SCC) frequently develop second primary SCC of the head and neck (HNSCC) synchronously and/or metachronously [1]. Previous studies reported that narrow-band imaging (NBI) was useful for identifying HNSCC at an early stage [2] and that endoscopic submucosal dissection (ESD) [3] could be used for treatment. In this report, we describe a case of earlystage HNSCC developing metachronously 1.5 years after esophageal cancer surgery that was detected and successfully treated. A 64-year-old man was admitted to Beijing Military General Hospital because of HNSCC, whichwas found by follow-up endoscopy after surgical treatment of esophageal SCC. On NBI (●" Fig.1), followed by white-light imaging (●" Fig.2), an oval, flat–elevated mucosal lesion with an estimated size of 1.0×1.3cm was detected on the right pyriform sinus. Magnified NBI showed an intrapapillary capillary loop (IPCL) type V2 lesion (●" Fig.3). ESD was successfully achieved (●" Fig.4) with the patient under general anesthesia and endotracheal intubation. The en bloc resected specimen measured 1.0×1.3cm (●" Fig.5). Histopathologic examination showed complete resection of a high grade intraepithelial neoplasm, and margins were histologically tumor-free (●" Fig.6). No residual lesionor recurrencewas found at latest follow-up esophagogastroduodenoscopy. For ESD we used an injection needle from MTW Endoskopie (Wesel, Germany), injection of sodium hyaluronate (Shanghai, China) to form the submucosal cushion, and a transparent hood and Dual-Knife from Olympus (Tokyo, Japan). We used a GIF-H260 endoscope for examination, a GIF-H260Z for identification of the IPCL type, and a GIF-Q260J for treatment, all from Olympus. Muto et al. [4] suggested that NBI could be the standard examination for early detection of superficial cancer in the head and neck region and the esophagus. In accordance with their results, we have switched from white light to NBI mode to inspect the head and neck region and the esophagus from the beginning of the endoscopic examination. In the case reported here, using NBI and ESD, we were able to detect and treat high grade intraepithelial neoplasia in the head and neck region without any complication. Fig.1 Narrow-band image shows an oval, flat–elevated, well-demarcated brownish area. Fig.2 White light image of the same lesion.

endoscopy

Endoscopic submucosal dissection of high grade intraepithelial neoplasia of the head and neck in a patient after surgical resection of esophageal cancer