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Intramural esophageal dissection is a rare disease characterized by a laceration of the submucosal layer in the esophageal wall due to mechanical damage or esophageal pressure, resulting in the separation of the mucosal layer from the muscularis layer. This report presents a case of intramural esophageal dissection induced by vomiting during barium esophagography in a 70-year-old man undergoing evaluation for esophageal cancer. Preoperative assessments included endoscopic biopsies and the placement of a marking clip, followed by barium esophagography. During the procedure, the patient experienced vomiting and subsequent neck-chest pain. Computed tomography revealed a barium-filled dissection cavity within the esophagus. Esophagogastroduodenoscopy identified submucosal dissection proximal to esophageal cancer, exposing the muscularis layer and the entry site was at the same level as the biopsy site. The patient was treated conservatively with fasting, leading to symptom resolution. Follow-up endoscopic evaluations confirmed that the entry site remained open but epithelialized, and the esophageal wound had healed.

This case report reported a case of huge esophageal hematoma caused by chewing betel nut. The patient was admitted to the hospital due to chest pain. After a multidisciplinary diagnosis by the Department of Gastroenterology, Cardiology, and Radiology, it was finally determined that the patient's chest pain was caused by a huge esophageal hematoma. After diagnosis and treatment, we observed the longitudinal ulcer after the healing of the esophageal giant hematoma. This case report provides evidence that chewing betel nuts may be a cause of gastrointestinal bleeding.

In Japan, differentiated-type early gastric cancer with submucosal invasion <500 µm, tumor diameter <3 cm, no lymphovascular invasion, and negative resection margin are included in pathological curative criteria after endoscopic resection (ER). However, there are a few reports presenting local or metastatic recurrence after ER for the lesions described above. A 72-year-old man was diagnosed with early gastric cancer and underwent endoscopic submucosal dissection (ESD). Pathological diagnosis was well-differentiated tubular adenocarcinoma, 8 × 6 mm, T1b1(SM1; 428 µm below the muscularis mucosae), negative lymphovascular invasion, and negative resection margin, which was included in curative criteria. Eighteen months after ESD, the laboratory studies indicated an increase in carcinoembryonic antigen of 17.6 ng/mL (normal range <5 ng/mL). While endoscopy showed no local recurrence finding, contrast-enhanced computed tomography (CT) showed a metastatic liver tumor in S4. Gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging and ¹⁸F-fluorodeoxyglucose positron emission tomography/CT revealed metastatic liver tumors in S4, S5, and S8. The liver biopsy specimen showed tubular adenocarcinoma and the findings of immunochemical staining were similar to that of the specimen of prior ESD. Thus, he was diagnosed with multiple liver metastatic recurrences after curative ER. Currently, it has been 3 years and 5 months since ESD and 1 year and 11 months since liver metastatic recurrence, and the patient has survived receiving 5th-line systemic chemotherapy. Here, we report a rare case of liver metastatic recurrence 18 months after curative ESD for early gastric cancer.

Hereditary diffuse gastric cancer (HDGC) is an autosomal dominant cancer caused by CDH1 mutation. HDGC causes multiple signet ring cell carcinomas (SRCCs) throughout the stomach. Few reports exist on the endoscopic findings during screening endoscopy, leading to the diagnosis of HDGC in its early stages. Recently, a new image-enhancement endoscopy technique, texture and color enhancement imaging (TXI), has been developed to improve the visibility of early gastric cancer. To the best of our knowledge, the use of TXI leading to HDGC diagnosis has not been reported. In this report, TXI contributed to the diagnosis of HDGC, and the patient was treated with total gastrectomy. A 27-year-old woman with a family history of gastric cancer underwent esophagogastroduodenoscopy, which revealed two pale lesions in the lower body of the stomach. Histological examination of the biopsy specimen revealed SRCC and the patient was referred to our hospital for treatment. Multiple lesions were found in the lower body using TXI, and a targeted biopsy confirmed other SRCCs. We suspected her disease to be HDGC, and the patient underwent a total gastrectomy. Histopathology showed multiple SRCCs (>60), but no lymph node metastases. Genetic testing revealed CDH1 mutations. The final pathological stage of the tumor was pT1a(m) N0M0 Stage I. TXI may be helpful in detecting multiple SRCCs in patients with HDGC. Endoscopists should be aware of HDGC, and careful investigation of the entire stomach is required for patients with diffuse-type gastric cancer before treatment.