A case of primary adenocarcinoma of the cervical esophagus arising from the ectopic gastric mucosa

Adenocarcinoma of the cervical esophagus arising from the ectopic gastric mucosa is a rare form of tumor, and only 25 cases have been reported previously. We present a case of a 74-year-old man who complained of dysphagia. Esophagogastroduodenoscopy revealed an elevated lesion located on the right posterior wall of the cervical and upper thoracic esophagus. Total esophagectomy and three-field lymph node dissection was performed. The tumor was 7.3 cm × 4.5 cm in size and of an ulcerative and localized type. Microscopic examination revealed a papillary adenocarcinoma with invasion to the adventitial layer. Its origin was diagnosed as ectopic gastric mucosa in the cervical esophagus, which lay adjacent to the tumor.     

Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification

The prevalence of heterotopic gastric mucosa (HGM) in the cervical esophagus is frequently underestimated. Tiny microscopic foci have to be distinguished from a macroscopically visible patch, also called "inlet patch." Symptoms as well as morphologic changes associated with HGM are regarded as a result of the damaging effect of acid, produced by parietal cells in the mostly fundic type of HGM. We herein review the literature and propose a new clinicopathologic classification of esophageal HGM: Most of the carriers of esophageal HGM are asymptomatic (HGM I). Some individuals with HGM in the esophagus complain of dysphagia, odynophagia, or "extraesophageal manifestations" (hoarseness and coughing), without further morphologic findings (HGM II). Still fewer patients are symptomatic due to morphologic changes, i.e., esophageal strictures, webs, or esophagotracheal fistula (HGM III). Malignant transformation via dysplasia (intraepithelial neoplasia, HGM IV) to cervical esophageal adenocarcinoma (HGM V) is exceedingly rare (only 24 reported cases). In contrast to Barrett's esophagus, HGM should not be regarded as a precancerous lesion. Symptoms are more likely to occur in patients with inlet patch, whereas malignant transformation and adenocarcinogenesis can also occur in microscopic HGM foci. Asymptomatic HGM requires neither specific therapy nor endoscopic surveillance. Only in symptomatic cases treatment, i.e., dilatation for (benign) strictures or acid suppression for reflux symptoms, can be recommended. Patients with low-grade dysplasia in HGM might be candidates for surveillance strategies, whereas in cases of high-grade dysplasia and invasive adenocarcinoma oncological treatment strategies must be employed.     

Giant fibrovascular polyp of the esophagus: MRI is useful for diagnosis and surgical planning

In the surgical field, benign esophageal tumors are much more uncommon than esophageal malignancies. In particular, fibrovascular polyps of the esophagus are extremely rare. We present a case involving a giant fibrovascular polyp (22 cm × 9 cm) in which not only location and site of origin but also precise polyp type were diagnosed preoperatively using magnetic resonance imaging (MRI). The lesion was then resected safely using a cervical approach. MRI is useful for acquiring valuable information about fibrovascular polyps. This case demonstrates the utility and safety of transcervical esophagotomy in the treatment of giant fibrovascular polyp of the esophagus.     

Esophagectomy for Barrett’s esophagus: Indications, techniques, and outcome

Opinion statement Barrett’s esophagus describes metaplastic changes from squamous mucosa to specialized columnar epithelium that can progress from low-grade dysplasia to high-grade dysplasia and even invasive carcinoma. The treatment of Barrett’s esophagus with low-grade dysplasia or Barrett’s adenocarcinoma is relatively standardized; however, controversy remains regarding appropriate therapy for Barrett’s esophagus with high-grade dysplasia. Treatment recommendations for high-grade dysplasia vary widely, from periodic endoscopic surveillance to endoscopic ablative therapies and esophagectomy. Selected studies have shown that a relatively high percentage (41% to 47%) of patients with high-grade dysplasia have occult carcinoma. In these patients, surgery is indicated, as esophagectomy can be curative for early stage adenocarcinoma in Barrett’s esophagus. A major criticism of esophagectomy is the significant morbidity and mortality. Minimally invasive esophagectomy was developed in an effort to reduce the morbidity associated with open esophagectomy. In minimally invasive esophagectomy, the abdominal laparotomy is replaced with laparoscopy, and the conventional right thoracotomy is replaced with thoracoscopy to reduce the operative trauma. In experienced centers, minimally invasive esophagectomy is now an attractive alternative for the treatment of Barrett’s esophagus with high-grade dysplasia.     

The expression of CD66a and possible roles in colorectal adenoma and adenocarcinoma

Background The aim of our study was to analyze the expression and possible role of CD66a in colorectal adenoma and adenocarcinoma and the relationship between its expression and pre-operation serum carcinoembryonic antigen (CEA) level and tumor stage in patients with colorectal adenocarcinomas. Methods Paraffin-embedded sections from 184 patients including 42 colorectal adenomas with low-grade dysplasia, 43 adenomas with high-grade dysplasia, and 99 adenocarcinomas were collected for this study. Immunohistochemical analysis was performed, and the expression and the location of CD66a were evaluated and were correlated with β-catenin nuclear expression. Results The expression of CD66a was found not only in the apical membrane of neoplastic glands but also in secretion within the lumen of the neoplastic glands including adenomas and adenocarcinomas. Expressions of secreted CD66a were of higher level in adenocarcinoma than in adenoma with high-grade dysplasia and adenoma with low-grade dysplasia (p < 0.0001). High expression of secreted CD66a was also associated with tumor stage, invasion, and pre-operation serum CEA level of patients with colorectal adenocarcinoma. Conclusions This study implied that CD66a can function both as an epithelial cell adhesion protein or alternatively as secreted CD66a. In addition, a high expression of CD66a was significantly correlated with tumor invasion, stage, and pre-operation serum CEA level.     

A renewed insight into Barrett's esophagus: comparative histopathological analysis of esophageal columnar metaplasia

Specialized intestinal metaplasia (SIM) is considered as a premalignant condition of the esophagus, but other types of esophageal metaplasia are commonly neglected. A standardized histopathological analysis was focused not only on SIM but also on the presence of metaplastic processes typical of additional glands. A morphological study using standardized histopathological tests was carried out between 2004 and 2007, with biopsies taken from esophageal mucosa of 826 consecutive patients. Mean age and male : female ratio of patients were 55.6 ± 14.7 and 1.1 : 1, respectively. Only 4.1% (n = 34) of all cases proved to have SIM. The remainder of the cases (n = 615; 74.4%) contained cardiac-fundic mucosa without SIM. Some samples exhibited superficial mucous glands, pancreatic acinar metaplasia (PAM), and ciliated metaplasia accounting for 24% (n = 198), 14.9% (n = 123), and 0.2% (n = 2), respectively. SIM was colocalized with superficial mucous glands (103/198 superficial mucous gland cases; P < 0.001). Low-grade dysplasia (n = 51; 6.2%) and high-grade dysplasia (n = 9; 1.1%) were found mainly in SIM (37/51; 9/9; P = 0.071) with male preponderance (3 : 1 at low-grade and 2 : 1 at high-grade dysplasia). PAM was found mainly in cases without dysplasia (103 of 123 pancreatic metaplasias; P < 0.001). SIM alone in the esophagus is rare, and its frequent association with cardiac mucosa-type metaplasia testifies to transition of mucinous-goblet cell through pseudogoblet cells. PAM rather indicates absence of dysplasia, but superficial mucous glands predicts that SIM follows dysplasia.     

High power setting argon plasma coagulation for the eradication of Barrett's esophagus

OBJECTIVE: The term Barrett's esophagus refers to a premalignant condition that is characterized by the replacement of the esophageal squamous mucosa by a columnar-lined one. Preliminary studies have demonstrated reversal of Barrett's mucosa after endoscopic coagulation with different techniques associated with acid inhibition. However, most of these studies have shown that residual Barrett's glands are found underneath the new squamous epithelium in up to 40% of patients. The goal of our study is to verify whether complete restoration of Barrett's mucosa can be achieved by the combination of high power setting argon plasma coagulation and omeprazole. METHODS: A total of 33 patients (mean age: 55.2 yr, range: 21-84 yr; 21 men and 12 women) with histologically demonstrated Barrett's esophagus (mean length: 4.05 cm, range: 0.5-7 cm) were treated. Fourteen cases presented with low-grade dysplasia and one with high-grade dysplasia. All of the extent, or until a maximum of 4 cm, of the Barrett's mucosa was cauterized in each session using argon beam coagulation at a power setting of 65-70 W. All patients received 60 mg omeprazole during the treatment period. RESULTS: Complete restoration of squamous mucosa was obtained in all 33 cases after a mean of 1.96 sessions (range, 1-4). Endoscopic results were histologically confirmed. Nineteen (57.5%) patients experienced moderate to severe chest pain and odyno-dysphagia lasting for 3-10 days after the procedure. Five of these cases experienced high fever and a small volume of pleural effusion, and three patients developed esophageal strictures that needed to be dilated. Another patient developed pneumomediastinum and subcutaneous emphysema without evidences of perforation. After a mean follow-up of 10.6 months there was one endoscopic, as well as histological, recurrence of Barrett's mucosa in a patient with an ineffective laparoscopic fundoplication. CONCLUSIONS: High power setting argon plasma coagulation combined with intensive acid suppression is an effective treatment for the total endoscopic ablation of Barrett's esophagus, at least in the short term. Long-term follow-up of treated patients in whom gastroesophageal reflux is surgically or medically alleviated seems mandatory before drawing definitive conclusions about this therapy.     

Risk factors for dysplasia in patients with Barrett's esophagus (BE): results from a multicenter consortium

Studies show Barrett's esophagus prevalence increases with age, while mean length of Barrett's esophagus is unchanged. Few data are available about the relationship between age and length on the development of dysplasia. Our aim was to assess age and length as risk factors for dysplasia. Consecutive patients with Barrett's esophagus were enrolled in a multicenter studyestablishing a tissue bank of Barrett's esophagus patients 1994 and 1998. Demographics, length of Barrett's esophagus (centimeters), and histology were recorded. Risk factors for dysplasia were assessed, including patient age, gender, and length of Barrett's esophagus. Statistical analysis was performed comparing prevalence of dysplasia (which included the presence of any carcinoma and high- or low-grade dysplasia) to age and length. In all, 309 patients were studied [278 (90%) male and 31 (10%) female]: 5 had adenocarcinoma of the esophagus, 11 had high-grade dysplasia, and 29 had low-grade dysplasia. Patients with Barrett's esophagus without dysplasia were younger than those with dysplasia [62 ± 0.8 years vs 67 ± 1.7 years (mean ± SEM, P = 0.02)]. The risk of dysplasia increased by 3.3%/yr of age. Mean length of Barrett's esophagus in patients with Barrett's alone vs dysplasia was 4.0 ± 0.2 cm vs 5.4 ± 0.4 cm (P = 0.003). Patients with Barrett's esophagus length 3 cm had a significantly greater prevalence of dysplasia compared to length <3 cm (23% vs 9%, P = 0.0001). The risk of dysplasia increased by 14%/cm of increased length. Multivariate analysis showed age and length to be independent risk factors. In conclusions; prevalence of dysplasia is strongly associated with age and length of Barrett's esophagus. These preliminary results can be used to develop a strategy for screening/surveillance based on age and length of Barrett's epithelium.     

Small benign tumors of the esophagus: radiological diagnosis with double-contrast examination

Benign tumors of the esophagus are rare. So far radiological examination has been useful in the diagnosis of fairly large benign tumors. In 4100 consecutive double-contrast studies we have found 22 incidental cases of protruded lesions of the esophagus with the appearance of submucosal tumor (8 cases) or polyp of the mucosa (14 cases). The lesions were small: 14 were less than 1 cm and 8 were between 1 and 3 cm. The histological data showed leiomyoma in the submucosal tumors and squamous papillomas in the polyps of the mucosa. A noteworthy feature is the unusual frequency of small squamous papillomas detected. The radiological diagnosis of benign tumors of the esophagus cannot be confined to large tumors in symptomatic patients but may include the accidental detection of small tumors. These call for histological verification and possibly endoscopic removal.     

DNA aneuploidy and histologic dysplasia in long-standing ulcerative colitis

PURPOSE: This study was designed to assess the presence of DNA aneuploidy and mucosal dysplasia, respectively, in 63 patients with long-standing ulcerative colitis. METHODS: The DNA content in colonic biopsies was investigated, using a flow cytometry method, and compared with conventional histology. Patients were subsequently followed each or every second year with colonoscopy and histology. A second flow cytometry examination to monitor the DNA pattern was performed after 10 years. RESULTS: Initially, abnormal DNA pattern (i.e.,aneuploidy) was found in 13/63 (21 percent) patients. The colonic mucosa was flat in 10, polypoid in 1, and tumor infiltrated in 2. Eight of the 10 aneuploid cases with a flat mucosa showed no signs of histologic dysplasia. In one of two cases with simultaneous aneuploidy and low-grade dysplasia, a carcinoma Dukes B was found at subsequent colectomy. On the other hand, dysplasia (one low grade and one high grade) without aneuploidy was found in two patients at the initial investigation. After 10 years, 13 had been colectomized, 11 had died (7 noncolitis related), and 3 were lost to follow-up. In the remaining 36 living patients with intact colorectum, no case of histologic dysplasia, but 6 cases of DNA aneuploidy were discovered at the initial investigation. Of the six aneuploid cases, one was later reclassified as diploid and one consisted of an aneuploid adenomatous polyp (removed by polypectomy). At follow-up 10 years later, 3/4 of the other aneuploid cases showed repeated abnormal DNA pattern, now together with histologic low-grade dysplasia (in flat colon mucosa). The 30 patients with initially normal DNA patterns were all still diploid at reexamination 10 years later, but 2 now revealed low-grade dysplasia histologically. CONCLUSIONS: DNA aneuploidy in chronic ulcerative colitis seems to be stable and it may precede histologic dysplasia by many years. It appears to be an additional marker for detecting neoplastic transformation in ulcerative colitis.     

Study ofHelicobacter pylori colonization of patches of heterotopic gastric mucosa (HGM) at the upper esophagus

Helicobacter pylori (HP), known to cause active chronic gastritis, has primarily been found in gastric-type mucosa. Even in the duodenum, the organism was detected in islands of metaplastic gastric mucosa. HP has also been found in gastric metaplasia of Barrett's esophagus in 15–50%. The aim of our study was to determine: (1) the frequency with which HP is found on histopathological sections of heterotopic gastric mucosa (HGM) patch(es) at the upper esophagus, as compared to that of the stomach proper, and (2) the histopathological significance of infection in the HGM patches. From 63 patients with HGM patches at the upper esophagus, 48 patients were found to have concurrent adequate specimen from the stomach for modified Steiner's stain. In 22 patients (45.8%), pair sections from HGM and stomach were negative for HP. Of 26 patients (54.1%) HP-positive on sections from the antrum and/or body (both in 21 cases) nine patients (18.7%) demonstrated HP in the HGM patches. Whereas focal acute inflammatory changes on the H&E section of HGM was present in six patients, HP was detected in HGM only in one. Chronic inflammatory cell infiltration was detected in all nine HP-positive HGM patches and in 37 of 39 HP-negative patches. A mixed acute and chronic inflammatory cell infiltration was found in five of these 37 patients. Our data demonstrate that HP infection of HGM patches at the upper esophagus is part of the HP gastritis and an independent colonization of HGM patches without gastric infection does not occur. No correlation was found between the presence of acute and chronic inflammatory changes in H&E-stained section and positivity of HP in modified Steiner's section of HGM.This study was presented in part, as poster, at the Digestive Disease Week of the AGA, May 12–18, 1990, in San Antonio, Texas.     

Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

AIM:To compare the diagnostic yield of heterotopic gastric mucosa(HGM)in the cervical esophagus with conventional imaging(CI)and narrow-band imaging(NBI).METHODS:A prospective study with a total of 760patients receiving a CI examination(mean age 51.6years;47.8%male)and 760 patients undergoing NBI examination(mean age 51.2 years;45.9%male).The size of HGM was classified as small(1-5 mm),medium(6-10 mm),or large(>1 cm).A standardized questionnaire was used to obtain demographic characteristics,social habits,and symptoms likely to be related to cervical esophageal HGM,including throat symptoms(globus sensation,hoarseness,sore throat,and cough)and upper esophageal symptoms(dysphagia and odynophagia)at least 3 mo in duration.The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.RESULTS:Cervical esophageal HGM was found in 36of 760(4.7%)and 63 of 760(8.3%)patients in the CI and NBI groups,respectively(P=0.007).The NBI mode discovered significantly more small-sized HGM than CI(55%vs 17%;P<0.0001).For the 99 patients with cervical esophageal HGM,biopsies were performed in 56 patients;37(66%)had fundic-type gastric mucosa,and 19 had antral-type mucosa.For the clinicopathological classification,77 patients(78%)were classified as HGMⅠ(asymptomatic carriers);21 as HGMⅡ(symptomatic without morphologic changes);and one as HGMⅢ(symptomatic with morphologic change).No intraepithelial neoplasia or adenocarcinoma was found.CONCLUSION:NBI endoscopy detects more cervical esophageal HGM than CI does.Fundic-type gastric mucosa constitutes the most common histology.One-fifth of patients have throat or dysphagic symptoms.     

Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report

Heterotopic gastric mucosa (HGM) of the esophagus is a congenital anomaly consisting of ectopic gastric mucosa. It may be connected with disorders of the upper gastrointestinal tract, exacerbated by Helicobacter pylori. The diagnosis of HGM is confirmed via endoscopy with biopsy. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. HGM located in the distal esophagus needs differentiation from Barrett''s esophagus. Barrett''s esophagus is a well-known premalignant injury for adenocarcinoma of the esophagus. Malignant progression of HGM occurs in a stepwise pattern, following the metaplasia–dysplasia–adenocarcinoma sequence.We present a rare case of a teenage girl with HGM located in the distal esophagus, associated with chronic gastritis and biliary duodenogastric reflux. Endoscopy combined with biopsies is a mandatory method in clinical evaluation of metaplastic and nonmetaplastic changes within HGM of the esophagus.     

Incidence of and risk factors for dysplasia in mucosectomy area in ulcerative colitis patients undergoing restorative proctocolectomy

Background and aims We evaluated the incidence of dysplasia in the mucosectomy area using resected specimens to determine preoperative risk factors for the occurrence of dysplasia in this area. Patients and methods We prospectively studied a consecutive series of 137 patients, each of whom underwent a restorative proctocolectomy with a mucosectomy and hand-sewn ileal J-pouch anal anastomosis between January 2003 and December 2004. Sections from the anal transitional zone mucosa were taken from the dentate line to 2.5 cm above the resected line and stained with hematoxylin and eosin then characterized as indefinite for dysplasia, low-grade dysplasia, and high-grade dysplasia based on the criteria of an international working group for rectal mucosal atypia. Results Dysplasia of the mucosectomy area was present in six (4.4%) of the patients, including one with low-grade and five with high-grade dysplasia. A multivariate analysis showed relations between age at time of surgery (≥40 years) and duration of disease (≥10 years) with a risk for development of mucosectomy area dysplasia. Conclusion The incidence of dysplasia of the mucosectomy area was 4.4%, and preoperative risk factors were shown to be duration of disease and age at time of surgery.     

Heterotopic gastric mucosa in gallbladder associated with kidney agenesis and congenital hip dysplasia

Heterotopic gastric tissue in the gallbladder is an extremely rare condition. There is not any specific clinical or laboratory finding and correct diagnosis is not possible before histopathological examination. Preoperative diagnosis usually resembles a polypoid Lesion or a fixed gallstone. We reported a 34-year-old female patient with heterotopic gastric mucosa in the gallbladder associated with congenital hip dysplasia and kidney agenesis. Laparoscopic cholecystectomy was performed and histopathology of the resected specimen showed that the "polyp" consisted of heterotopic gastric mucosa with glands of body and fundic type. Some cases of heterotopia in the gallbladder come from metaplasia, and may be one of the causes of gall bladder cancer. We discussed the clinical and histologic features of heterotopic gastric tissues and reviewed reported cases in the literature.     

Randomized crossover study that used methylene blue or random 4-quadrant biopsy for the diagnosis of dysplasia in Barrett's esophagus

BACKGROUND: Barrett's esophagus is generally accepted to be a premalignant condition. Previous studies have suggested the use of methylene blue (MB) chromoendoscopy to aid the identification of dysplasia in Barrett's esophagus surveillance programs, but a recent study has raised the concern that MB might induce oxidative damage of DNA. OBJECTIVE: The aim of this study was to compare MB directed biopsies (MBDB) with our current standard, which is random 4 quadrant biopsies (RB). DESIGN: A randomized prospective crossover study. SETTING: Single center. PATIENTS: Patients with a diagnosis of dysplasia identified in Barrett's esophagus within a 2-year period before entering the study. INTERVENTIONS: Either 4 random quadrant biopsies taken every 2 cm through the length of the Barrett's esophagus or MBDB from unstained or heterogenously stained mucosa. MAIN OUTCOME MEASUREMENTS: The number of patients with a diagnosis of dysplasia by each intervention. LIMITATIONS: Thirty-six percent of eligible patients declined the invitation to participate. RESULTS: Thirty patients completed the crossover study. The median length of Barrett's esophagus was 5 cm (interquartile range [IQR] 3-9 cm). At baseline histology, grades were as follows: 17 low-grade dysplasia (LGD), 3 high-grade dysplasia (HGD), and 10 no dysplasia. At completion, there were 10 LGD, 8 HGD, and 12 no dysplasia. Overall, dysplasia was identified in 17 of 18 patients by RB and in 9 of 18 by MBDB (McNemar test, p = 0.02). CONCLUSIONS: Our study showed MBDB to be significantly less sensitive in detecting dysplasia than RB in Barrett's esophagus. Hence, we discourage its use during routine surveillance of Barrett's esophagus.     

What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus

We have reviewed articles on the longitudinal vessels observed in the lower esophagus. In our previous study, we observed longitudinal (palisading) vessels through the mucosal epithelium in 884 (98%) of 905 consecutive endoscopic examinations of the lower esophagus, whereas in 20 examinations (2%) they could not be observed because of inflammation. The lengths of the longitudinal vessels were within the range of 2 to 3 cm in 90% of investigations. “Indentation” (notch or narrowing) compatible with the esophageal hiatus was observed in the transitional zone between the tubal esophagus and saccular stomach by both radiographic (as an indentation) and endoscopic (as a narrowing; we used the term indentation in this article) examinations. In cases without hiatal hernia, the indentation coincided with the esophagogastric junction (EGJ). We examined endoscopically the relationships among the locations of the indentation, squamocolumnar junction, and the longitudinal vessels. In no patients did we observe longitudinal vessels through the gastric mucosa beyond the indentation. Therefore, observation of longitudinal vessels through the mucosal epithelium was an indicator that the mucosa was located within the esophagus. However, in 21% of the 884 observations, columnar-lined mucosa was seen continuously from the gastric mucosa proximally beyond the indentation, and longitudinal vessels were observed through this columnar-lined mucosa. Because the longitudinal vessels were peculiar to the esophageal mucosa, we could assume that this columnar-lined mucosa was located within the esophagus and was Barrett's mucosa, although very short. Therefore, Barrett's mucosa can be precisely diagnosed endoscopically by using the longitudinal vessels as diagnostic markers. The Japan Esophageal Society has authorized the endoscopic definition that the lower ends of the longitudinal vessels mark the limit of the EGJ.     

A CASE OF SIALADENOMA PAPILLIFERUM OF THE ESOPHAGUS

Sialadenoma papilliferum of the esophagus is an extremely rare benign tumor that derives from the submucosal gland duct of the minor salivary gland. A 45‐year‐old man underwent upper gastrointestinal series. A 13 mm diameter esophageal polyp was suspected in the mid esophagus. Endoscopy examination revealed a pedunculated polyp arising from the posterior wall of the esophagus. The head of the polyp was covered with exudate and was slightly nodular but the pedicle had normal mucosa. We performed endoscopic mucosal resection (EMR) and the histological examination of the polyp showed that it was compatible with sialadenoma papilliferum of the esophagus.     

Retrieval of colorectal polyps following snare polypectomy: experience of the multiple-suction technique in 602 cases

Background Retrieving colorectal polyp after endoscopic snare polypectomy is time consuming and possibly incurs a failure. The aim of the study was to assess the effectiveness of the multiple-suction (M-S) technique for retrieving a variety of polyps. Materials and methods Four hundred and nine cases received endoscopic snare polypectomy from January 2003 to January 2007 were reviewed. The resected polyps were retrieved by M-S technique, in which suction regarded as the leading technique, was taken in combination with channel occlusion, trap, snare, and grasping forcep. Time of cecal intubation and of polypectomy, total examination time, shape, size, location, and number of polyp(s) were recorded. Retrieval time and polyp lost rate were also noted. Results A total of 602 polyps more than 3 mm in diameter underwent snare polypectomy. There were 96.7% (582/602) of polyps retrieved by the M-S technique. The mean retrieval time was 1.5 ± 0.6 min. Time of polypectomy, retrieval time, and total examination time were significantly positive correlative with the number of polyps (P < 0.05). In a univariate analysis, longer retrieval time was significantly associated with larger polyps, more distant polyps from the anus, and a greater number of polyps, while higher polyp lost rate was significantly associated with sessile polyp, smaller polyps, and a greater number of polyps. In a multivariate analysis, retrieval time level (≤2.0 or >2.0 min) was linked to the number of polyps. Conclusions The M-S technique is proved to be reliable when used in the majority cases of colorectal polyp retrieval. In retrieving too many polyps, the M-S technique is time consuming, and hence, additional methods should be applied to improve its retrieval effectiveness.     

Diagnostic value of endoscopic and endoscopic ultrasound characteristics of duodenal submucosal tumour-like heterotopic gastric mucosa

OBJECTIVE:

Recent studies have reported that duodenal heterotopic gastric mucosa (HGM) has been observed in 8.9% of patients who undergo esophagogastroduodenoscopy. However, there are few reports concerning the endoscopic and endoscopic ultrasound characteristics of submucosal tumour-like HGM in the duodenum.

METHODS:

Endoscopic, endoscopic ultrasound (EUS) and histological findings were analyzed in six patients with submucosal tumour-like HGM, which were confirmed by pathological examination of biopsy or endoscopic polypectomy specimens.

RESULTS:

Endoscopically, the lesions appeared as a solitary, sessile submucosal tumour-like mass with a depression at the top. In four of six patients, small granular structures were found in the depressed area of the mass. On EUS, all masses demonstrated a heterogeneous pattern, among which four patients presented anechoic areas while two patients showed no anechoic areas. All lesions were localized within the mucosa and submucosa on EUS. Histologically, they consisted of gastric glands and some dilated glands, and were covered with normal duodenal epithelium. In four of six lesions, the tumours were composed of gastric-type foveolar epithelium showing papillary growth, fundic glands and pyloric glands, while the others consisted of gastric-type foveolar epithelium and pyloric glands.

CONCLUSION:

A heterogeneous pattern on EUS and small granular structures on esophagogastroduodenoscopy represent valuable diagnostic features of submucosal tumour-like HGM.