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Polyethylene glycol is a safe agent for bowel cleansing in preparation for colonoscopy. However, it can cause considerable electrolyte abnormalities. We herein report two cases of hyponatremia because of bowel preparation using polyethylene glycol. Case 1: The patient, a man in his 70s, was admitted to our hospital for an endoscopic mucosal resection of an adenoma of the large intestine. After the preparation, the patient developed consciousness disturbance. His serum Na level was 122 mEq/L, indicating a marked degree of electrolyte abnormality. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) was inferred as the cause of hyponatremia. Case 2: A patient in his 70s, based on a positive fecal occult blood test result, was scheduled to undergo colonoscopy. A blood test on the day of the colonoscopy showed his serum sodium level as 107 mEq/L. The patient was found to have chronic hyponatremia, which prevented development of clinical symptoms. However, because of preservation of ADH secretion despite the hyponatremia, a diagnosis of SIADH was made. These cases suggest that clinicians should be aware of the risk of hyponatremia during bowel preparation for colonoscopy.

We report about a patient with an extremely rare long-segment Barrett’s esophagus (LSBE) who developed extensive superficial adenocarcinoma and underwent radical (R0) resection based on an accurate preoperative diagnosis of tumor extent. A 68-year-old man with no subjective symptoms and no noteworthy medical history was diagnosed with adenocarcinoma after a biopsy of a protruding lesion in the lower esophagus. Narrow-band imaging (NBI) magnification endoscopy revealed that the protruded lesion was within the LSBE, and a flatly extended superficial esophageal adenocarcinoma (SEAC) was observed proximal to the protruded lesion. After confirming the extent of the tumorous lesion via endoscopic biopsy, subcircumferential endoscopic submucosal dissection (ESD) was performed for the extensive tumor, which resulted in a histological R0 resection. Prophylactic steroid therapy was performed to prevent refractory post-ESD stenosis. There was no residual tumor or recurrence of the cancer, and the patient’s postoperative course was favorable. Preoperative diagnosis of tumor extent using NBI magnification endoscopy may therefore be useful for characterizing SEAC occurring in the LSBE, given that detecting the presence and determining the extent of these tumors is normally difficult. Prophylactic therapy with local steroid injection can prevent refractory stenosis after quite extensive ESDs for SEACs in the LSBE.

We report about a patient with an extremely rare long-segment Barrett’s esophagus (LSBE) who developed extensive superficial adenocarcinoma and underwent radical (R0) resection based on an accurate preoperative diagnosis of tumor extent. A 68-year-old man with no subjective symptoms and no noteworthy medical history was diagnosed with adenocarcinoma after a biopsy of a protruding lesion in the lower esophagus. Narrow-band imaging (NBI) magnification endoscopy revealed that the protruded lesion was within the LSBE, and a flatly extended superficial esophageal adenocarcinoma (SEAC) was observed proximal to the protruded lesion. After confirming the extent of the tumorous lesion via endoscopic biopsy, subcircumferential endoscopic submucosal dissection (ESD) was performed for the extensive tumor, which resulted in a histological R0 resection. Prophylactic steroid therapy was performed to prevent refractory post-ESD stenosis. There was no residual tumor or recurrence of the cancer, and the patient’s postoperative course was favorable. Preoperative diagnosis of tumor extent using NBI magnification endoscopy may therefore be useful for characterizing SEAC occurring in the LSBE, given that detecting the presence and determining the extent of these tumors is normally difficult. Prophylactic therapy with local steroid injection can prevent refractory stenosis after quite extensive ESDs for SEACs in the LSBE.