Endoscopy 2018; 50(04): S34
DOI: 10.1055/s-0038-1637128
ESGE Days 2018 oral presentations
20.04.2018 – Esophagus: SCC, Barrett's, GERD
Georg Thieme Verlag KG Stuttgart · New York

ESOPHAGEAL “OUTLET PATCHY VESICLES”: ENDOSCOPIC, MAGNIFICATION ENDOSCOPY, HISTOLOGIC AND ELECTRONMICROSCOPIC DESCRIPTION OF NEW LESIONS AT THE GASTROESOOPHAGEAL JUNCTION

K Mönkemüller
1   Frankenwald Klinik, Gastroenterologie, Kronach, Germany
,
A Martínez-Alcalá García
2   Hospital Universitario Infanta Leonor, Madrid, Spain
,
C Delgado-Linares
3   Otto-von-Guericke University, Magdeburg, Germany
,
P Malfertheiner
3   Otto-von-Guericke University, Magdeburg, Germany
,
LC Fry
4   Frankenwald Klinik, Kronach, Germany
,
H Neumann
5   University of Mainz, Mainz, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
27 March 2018 (online)

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Aims:

We have often observed the presence of small yellow vesicles or tiny submucosal cysts above the Z-line in a significant number of patients. These lesions have not been described in the literature. The aim of this study was to evaluate the incidence of these lesions and characterize them endoscopically and histolgically.

Methods:

200 patients were prospectively and consecutively enrolled. The endoscopies were performed using standard and high-definition white light endoscopes with magnification (up to x 110). Histology (H&E). In 10 patients we also performed electron microscopy (magnification 7000x). All potential physiologic and pathologic lesions found in the esophagus and stomach were carefully searched and described for. The occurrence of these yellow vesicles was analyzed in the context of these lesions using univartiate and multivariate analysis, Mann-Whitney and Student t-test.

Results:

A total 197 were included (102 women and 95 men, mean age 55,5, SD+15) (three patiens were excluded). The incidence of yellow vesicles was 30% of EGDs. Some lesions had a shape of a “volcano” with zylidrical epithelium on its tip. Their sizes ranged from 3 mm to 12 mm. These yellow vesicles had a significant correlation with zylindrical esophageal epithelium (including Barrett esophagus) (p = 0,009) and inverse correlation with erosive esophagitis (p = 0.024) and female sex (p = 0,011). Histology and elctron microscopy demonstrated submucosal glands and zylindrical epithelium, including pancreatic and gastric metaplasia (the patholgist blinded to the study called these lesions “inlet patches”).

Conclusions:

Yellow vesicles in the distal esophagus are found in 30% of patients undergoing EGD for clinical symptoms. Yellow vesicles are inversely associated with columnar lined epithelium (Barrett esophagus) and positively associated with female sex and less erosive esophagitis, suggesting a protectiive mechanism of the GEJ. These lesions contain submucosal glands and gastric metaplasia and could be thus considered esophageal “outlet patches”.