Multidisciplinary Team Approach to the Management of Early Esophageal Adenocarcinoma in a Patient with Liver Cirrhosis, Portal Hypertension, and Severe Thrombocytopenia.

BACKGROUND: Esophageal adenocarcinoma in patients with liver cirrhosis and portal hypertension presents significant treatment challenges. This case highlights a multidisciplinary approach involving transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic submucosal dissection (ESD) for tumor resection. CASE PRESENTATION: A 60-year-old male with newly diagnosed liver cirrhosis was referred for routine esophagogastroduodenoscopy (EGD) to screen for esophageal varices. Endoscopy revealed an exophytic lesion in the distal esophagus (Paris 0-Ip) over a column of varices, and biopsy confirmed adenocarcinoma. Following a multidisciplinary tumor board discussion, the patient underwent TIPS to reduce portal hypertension, allowing for a safer endoscopic resection. INTERVENTION: After successful TIPS implantation and a significant reduction in portal pressure, ESD was performed. The tumor was removed en bloc, and histopathological examination confirmed curative resection with negative margins and no lymphovascular invasion. CONCLUSION: This case demonstrates the successful management of early-stage esophageal adenocarcinoma in a cirrhotic patient with severe portal hypertension using a combination of TIPS and ESD. It underscores the importance of a multidisciplinary strategy in managing complex cases.