Post written by Rajit Aziz Gilhotra, MBBS (Hons), FRACP, from the Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, Australia, and Neal Shahidi, MD, FRCPC, PhD, from the Department of Medicine, University of British Columbia, and the Digestive Health Centre, St Paul’s Hospital, Vancouver, Canada.

This case report shares the unusual, rare finding of esophageal squamous papillomatosis (ESP) that developed after endoscopic submucosal dissection (ESD) and radiofrequency ablation (RFA) of dysplastic Barrett’s esophagus.

This study carries the potential to help other endoscopists recognize this endoscopic finding and expands our understanding of potential Barrett’s endotherapy–related adverse events. 

ESD is a well-established modality for the management of Barrett’s neoplasia. This is followed by ablation of the residual Barrett’s esophagus by RFA. Esophageal stricturing is the most common reported adverse event of RFA with or without resection.

ESP is a rare and asymptomatic condition that is generally found incidentally at the time of diagnostic endoscopy. It is felt to arise secondary to chronic chemical irritation from gastroesophageal reflux and sometimes thought to be linked to human papillomavirus, although its pathophysiology is not well understood.

To our knowledge, ours is the first case that reports development of ESP post ESD and RFA for dysplastic Barrett’s esophagus. ESP has historically been considered a benign condition. However, dysplasia and squamous cell carcinoma have now been reported. Overall, as the risk of malignant potential is considered low, endoscopic surveillance was pursued in the aforementioned case.

Surveillance gastroscopy 6 months after endoscopic submucosal dissection and radiofrequency ablation.

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