Endoscopy 2019; 51(04): S112
DOI: 10.1055/s-0039-1681501
ESGE Days 2019 oral presentations
Saturday, April 6, 2019 11:00 – 13:00: Video ERCP 2 South Hall 1A
Georg Thieme Verlag KG Stuttgart · New York

DON'T SKIP THE GIP

P Leclercq
1   CHU Liège, Liège, Belgium
2   Maag-, Darm- en Leverziekten, UZ Leuven, Leuven, Belgium
,
V Jadot
1   CHU Liège, Liège, Belgium
,
R Bisschops
2   Maag-, Darm- en Leverziekten, UZ Leuven, Leuven, Belgium
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

 

Aim:

We report the case of a 59-year-old patient with intramucosal adenocarcinoma of the cervical esophagus, found within an esophageal inlet patch, successfully treated with endoscopic mucosal resection.

Methods:

A 59-year-old asymptomatic man with nondysplastic COM2 Barrett's esophagus history was referred to our institution for a surveillance upper esophagogastroduodenoscopy (EGD). EGD showed a cervical esophageal 5 mm Paris Is lesion, arising from an esophageal gastric inlet patch (GIP). Biopsies showed high grade intra-epithelial neoplasia within the polypoid lesion and confirmed gastric-type mucosa in the surrounding esophageal inlet tissue patch. Endoscopic ultrasonography showed no evidence of submucosal invasion or lymph node invasion. After multidisciplinary review, the patient was referred for endoscopic mucosal resection (EMR). En-bloc cap-assisted EMR of the suspicious nodule was realized under general anesthesia (see video). Final histology EMR specimen showed radically resected (R0) well-differentiated intramucosal adenocarcinoma pT1m3 with no lympho-vascular invasion. No immediate or delayed complications were encountered. A 3 and 6 months surveillance endoscopy showed no local recurrence.

Results:

Esophageal Gastric Inlet Patches (GIP) are composed of islands of heterotopic gastric columnar epithelium in the cervical esophagus. They are usually incidentally found at endoscopy and have a reported prevalence of 0,18 to 14,5%. The most frequently accepted theory concerning the origin of an esophageal GIP is the sequestration of gastric mucosa in the developing esophagus. Esophageal adenocarcinoma rarely occurs in the cervical esophagus and is most often linked to inlet patches. About fifty cases of adenocarcinoma arising from GIP have been reported in the literature. GIP may contain normal gastric mucosa but also intestinal metaplasia. Significant association between GIP and Barrett's esophagus have also been described.

Conclusion:

Esophageal GIP is a common underestimated and overlooked endoscopic finding. Even if regular GIP biopsies are not recommended, systematic careful endoscopic inspection should be advised to detect early malignancies.