Successful endoscopic submucosal dissection of early gastric cancer located on gastric varices after treatment with balloon-occluded retrograde transvenous obliteration

Gastric varices occur in patients with liver cirrhosis and cause major bleeding when they rupture. We report a case of an 80-year-old man with liver cirrhosis and chronic renal failure who was diagnosed with a gastric tumor located on gastric varices that had increased in size. The patient underwent balloon-occluded retrograde transvenous obliteration (BRTO) to control bleeding, and the gastric varices were eradicated. Two months after BRTO, endoscopic submucosal dissection (ESD) was performed, and en bloc resection was accomplished without severe intraoperative bleeding or complications during or after ESD. To our knowledge, this is the first report of successful treatment of early gastric cancer located on gastric varices by ESD in a patient with liver cirrhosis. Early gastric cancer located on gastric varices can be safely resected by performing BRTO prior to ESD.