Adenocarcinoma in childhood Barrett's esophagus: case documentation and the need for surveillance in children.

Abstract

A 17-yr-old boy underwent esophagectomy for multifocal high-grade dysplasia and adenocarcinoma complicating Barrett's esophagus (BE). He is believed to be the first child or young adult to have prolonged healthy survival following resection of esophageal adenocarcinoma. Dysplasia in a short retained segment of his Barrett's mucosa appears to have regressed with acid-suppressing therapy. Of nine other reported cases of adenocarcinoma in young people 11-25 yr of age, all died. All had progressive dysphagia and an esophageal mass at presentation, unlike our patient who had only histologic evidence of cancer at presentation. This was found only after repeated and extensive biopsy of the esophagus. We conclude that adenocarcinoma does occur under age 25 yr as a complication of BE arising in childhood, and it may be curable if diagnosed early. Endoscopic surveillance with multiple stepwise biopsies, beginning at age 10 yr, is suggested in those few children who have BE with specialized mucosa and goblet cells.