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Endoscopic resection is an accepted treatment modality for early esophageal neoplasia [1–3]. In patients with esophageal varices, however, endotherapy is contraindicated, although those patients are also precluded from esophagectomy. In patient 1 (a 66-year-old man), upper endoscopy showed esophageal varices (grade II– III) and a long Barrett’s segment containing a polypoid lesion (Paris 0-Ip) [4]. Endoscopic ultrasound (EUS) revealed varices directly beneath the stalk. We decided to snare the lesion with the Duette MBM device (Cook Endoscopy, Limerick, Ireland) mounted on the endoscope as a precautionary measure that would enable direct variceal ligation in case of bleeding. The resection was uneventful, and histolopathological examination showed an intramucosal adenocarcinoma. At 2 months, a recurrent neoplastic lesion was observed (Paris 0-IIa) at the exact location of the previous resection. This lesion was captured by means of one rubber band by which not only the lesion but also the underlying varix was ligated; however snaring was omitted since this would have led to a massive variceal bleed. During 4.5 years of follow-up, no recurrence was detected. Patient 2 (a 50-year-old man) had shortsegment Barrett esophagus, a Paris 0-IIa+

Endoscopic resection of early esophageal neoplasia in patients with esophageal varices: how to succeed while preventing the bleed