Colon micro- and macrooesofagisation in interposed pedicled colonic right half segments for esophagus reconstruction.

Treatment of esophageal burns may require surgical transplantation (interposition) of the colon or stomach. The interposed parts change their function and morphology. To investigate the macro- and microchanges in the transplanted colonic segment we analyzed in long-term follow-up (up to 29 years) the group of 21 patients in a retrospective study who underwent surgical interposition of pedicled colonic right half segments for esophageal burns. The data were analyzed statistically with the software package Statistica 13 (StatSoft Polska, Cracow). All calculations were performed with a significant level of P = .05. We evaluated the macro- and microanatomy of the grafts using radiology, endoscopy and histology. The adaptation of the transplanted tube was excellent. The diameter of the colonic tube was normal (35-60 mm) in 60% of females and 100% of males. Typical macrooesophagisation was found in all patients, while microoesophagisation involved inflammation, which gradually resolved over a period of about 5 years to be replaced by edema without fibrosis. Only in few patients persistent reflux was present, leading to erosions or ulcerations. All symptoms subsided after conservative treatment. We concluded macrooesophagization developed gradually after surgery, and was fully developed after 15 to 20 years. Microoesophagization appeared soon after interposition, and was obvious after 5 years. No metaplasia or dysplasia were observed (except in 1 patient), and the number of goblet cell remained constant.

Esophageal Stricture: An Uncommon Complication of Cervical Inlet Patch.

Esophageal heterotopic gastric mucosal patches (HGMP), also known as cervical inlet patches (CIP), is a rare but underdiagnosed condition characterized by the presence of salmon-colored, velvety mucosa located in the proximal esophagus, distal to the upper esophageal sphincter. The incidence of CIP ranges from 3% to 10% in adults, and its endoscopic appearance is characterized by a flat or slightly raised salmon-colored patch. In this case, we report a 78-year-old man who presented with symptoms of laryngopharyngeal reflux and dysphagia. An esophagogastroduodenoscopy showed a flat area of salmon-colored patch between 17 and 20 cm from the incisors, suggestive of a CIP complicated by stricture. The biopsy results showed an oxyntic-type mucosa lined with columnar cells consistent with an inlet patch. Esophageal dilation was done with a savory dilator with no resistance at 18 mm. The patient was placed on maintenance acid suppression therapy with proton-pump inhibitors and reported complete resolution of symptoms at the 1-month follow-up.

Esophageal epidermoid metaplasia. An unusual find.

A 62-year-old woman presented with an episode of upper gastrointestinal bleeding. Upper endoscopy revealed white exudates at the middle and lower third of the esophagus. Biopsies proved epidermoid metaplasia of the esophagus with low-grade dysplasia. We discuss the risk factors, preneoplastic potential and available treatments of this entity.

Laryngopharyngeal symptoms and oesophageal disorder: The role of heterotopic gastric mucosa in upper oesophagus.

BACKGROUND: Heterotopic gastric mucosa in the upper oesophagus (HGMUE) was considered as geneogenous manifestation. However, its clinical characteristics may be beyond our knowledge if we focus on its extra-oesophageal presentation. So the aim of this study was to investigate the relationship between HGMUE and laryngopharyngeal symptoms. METHOD: Eight hundred and eleven patients who had gastric endoscopy examination were enrolled in this study and the cervical oesophagus was examined for the patch during withdrawal of the endoscope. Questionnaire for gastroesophageal reflux disease (GERD-Q) and Reflux Symptom Index (RSI) were completed by all the patients. Pathology feature and therapeutic effect of HGMUE patients were evaluated. RESULT: About 34.53% of the patients undergoing the gastroduodenoscopy had laryngopharyngeal (LP) symptoms. The relevance rate of HGMUE in LP(+) group (10.69%) was higher than that in LP(-) group (2%). The LP symptoms were related to the histological type and expression of H+-K+-ATPase in the histological sample of HGMUE patients. The positive rate of H+-K+-ATPase was 100% in LP(+) group, and that in LP(-) group was 28.6%. PPI therapy was effective for improving the LP symptoms in HGMUE patients. The RSI score in LP(+) patients decreased from 8.12 ± 1.46 at baseline to 4 ± 0.74 at the end of 8 weeks after treatment of PPI. CONCLUSION: HGMUE was an important cause of LP symptoms in patients, especially in those who had no evidence of GERD. The mechanism of HGMUE-induced LP symptoms was due to its location and the function of acid secretion according to the endoscopic finding and histologic characteristics.

Esophageal lichen planus: Current knowledge, challenges and future perspectives.

Lichen planus (LP) is a frequent, chronic inflammatory disease involving the skin, mucous membranes and/or skin appendages. Esophageal involvement in lichen planus (ELP) is a clinically important albeit underdiagnosed inflammatory condition. This narrative review aims to give an overview of the current knowledge on ELP, its prevalence, pathogenesis, clinical manifestation, diagnostic criteria, and therapeutic options in order to provide support in clinical management. Studies on ELP were collected using PubMed/Medline. Relevant clinical and therapeutical characteristics from published patient cohorts including our own cohort were extracted and summarized. ELP mainly affects middle-aged women. The principal symptom is dysphagia. However, asymptomatic cases despite progressed macroscopic esophageal lesions may occur. The pathogenesis is unknown, however an immune-mediated mechanism is probable. Endoscopically, ELP is characterized by mucosal denudation and tearing, trachealization, and hyperkeratosis. Scarring esophageal stenosis may occur in chronic courses. Histologic findings include mucosal detachment, T-lymphocytic infiltrations, epithelial apoptosis (Civatte bodies), dyskeratosis, and hyperkeratosis. Direct immuno-fluorescence shows fibrinogen deposits along the basement membrane zone. To date, there is no established therapy. However, treatment with topical steroids induces symptomatic and histologic improvement in two thirds of ELP patients in general. More severe cases may require therapy with immunosuppressors. In symptomatic esophageal stenosis, endoscopic dilation may be necessary. ELP may be regarded as a precancerous condition as transition to squamous cell carcinoma has been documented in literature. ELP is an underdiagnosed yet clinically important differential diagnosis for patients with unclear dysphagia or esophagitis. Timely diagnosis and therapy might prevent potential sequelae such as esophageal stenosis or development of invasive squamous cell carcinoma. Further studies are needed to gain more knowledge about the pathogenesis and treatment options.

Sebaceous Gland Ectopia of the Esophagus: A Challenging Clinical Diagnosis.

BACKGROUND/AIM: Sebaceous gland ectopia (SGE) defines the presence of normal sebaceous tissue in an unusual location. This condition is rare and was first described in ectodermal-derived organs, such as the oral cavities and palms, and later in endodermal-derived tissues including the esophagus. SGE of the esophagus is believed to represent a form of acquired metaplasia. SGE is asymptomatic and usually discovered during routine endoscopic examinations for other gastrointestinal complaints and symptoms. It is a benign entity and to date no cases of malignant transformation have been reported. Once diagnosed, SGE requires no further work up or follow up, and does not require treatment. CASE REPORT: We present two cases of SGE arising in the esophagi of two female patients who presented with complaints of gastro-esophageal reflux and underwent endoscopy. These lesions presented as patchy yellow-white nodules in the mid and upper esophagus and were endoscopically interpreted as suggestive of candidiasis or glycogen acanthosis. Biopsies showed foci of non-keratinizing squamous mucosa overlying the sebaceous glands. These glands exhibited a characteristic lobulated structure with germinative cells at the periphery and vacuolated, well-differentiated cells in the center of the lobules. After histologic examination, the endoscopic impressions of candidiasis and acanthosis were ruled out and the final diagnosis of SGE was made. There was no evidence of dysplasia or malignancy in our cases. CONCLUSION: Histopathology examination is important to differentiate SGE from malignant and infectious conditions that are more common, and which can be clinically and endoscopically similar to SGE.

Acute Esophageal Necrosis: A Retrospective Cohort Study Highlighting the Mayo Clinic Experience.

OBJECTIVE: To describe the clinical, endoscopic, and histologic features in patients with acute esophageal necrosis (AEN). PATIENTS AND METHODS: In this retrospective cohort study, patients who were diagnosed as having AEN at Mayo Clinic sites in Minnesota, Florida, and Arizona between January 1, 1996, and January 31, 2021, were included. Data were collected on patient clinical characteristics and endoscopic and pathologic findings. RESULTS: The study included 79 patients with AEN with a median (range) age of 64 years (12 to 91 years); 53 (67.1%) were men. Predominant presenting symptoms were hematemesis (49 of 79 [62.0%]), abdominal pain (29 [36.7%]), and melena (20 [25.3%]). Shock was the triggering event for AEN in 49 (62.0%). The 30- and 90-day mortality were 24.0% (19 of 79) and 31.6% (25), respectively. The presence of coexisting infection or bacteremia was significantly associated with 90-day mortality (P<.01). Endoscopically, involvement of the distal third only, distal two-thirds only, and entire esophagus was observed in 31.6% (24 of 76), 39.5% (30), and 29.0% (22), respectively. The length of esophageal involvement correlated with duration of hospitalization (P=.05). The endoscopic appearance of the esophageal mucosa ranged from predominantly white (21 of 44 [47.7%]) to mixed white and black (13 [29.6%]) to predominantly black (10 [22.7%]), and sloughing was present in 18 (40.9%). In the 26 patients with histopathologic findings available for review, 25 (96.1%) had necrosis and/or ulceration with abundant pigmentation. Among the 79 patients, 39 (49.4%) had a follow-up esophagogastroduodenoscopy; 26 of these 39 patients (66.7%) had resolution while 5 had persistent AEN, 4 of whom had improvement. Esophageal strictures developed in 7 of the 39 patients (18.0%). CONCLUSION: Acute esophageal necrosis is a serious condition observed in critically ill patients. Its endoscopic appearance can be highly variable. In patients with an unclear diagnosis, esophageal biopsies may be helpful given the characteristic histologic findings.

The true prevalence of cervical inlet patch in a specific center dealing with esophageal diseases.

OBJECTIVE: Cervical Inlet Patch (CIP) is an interesting entity that is little known and often neglected by endoscopists. It has always been reported as less than expected. In this article, for the first time in the literature, we want to measure the true prevalence of CIP in a center dealing with specific esophageal diseases. PATIENTS AND METHODS: From October 2020 to October 2021, a total of 283 patients, aged 15-95 years, with mainly dyspeptic and reflux-like complaints were included in this study. All endoscopic procedures were performed carefully by a single endoscopist. Patients were examined for any possible presence of CIP, with adequate sedation and time. RESULTS: The prevalence of CIP, which was the primary aim of our study, was detected at a rate of 14.8%. Most CIP was observed as a single lesion (73.8%), and many of them (45.2%) were larger than 10 mm. Plenty of patients had upper endoscopy due to dyspeptic complaints, but only 2.5% of them presented with a preliminary diagnosis of laryngeal reflux. CONCLUSIONS: The true CIP prevalence is higher than reported before. Our result is the highest prevalence rate of CIP was detected in Turkey. In this regard, data coming from centers dealing with specific esophageal diseases may be more reliable and true.

Esophageal epidermoid metaplasia: an unusual condition.

A 66-year-old man with a history of tobacco and alcohol consumption was diagnosed with a severe peptic esophagitis. After treatment, an endoscopy showed the resolution of esophagitis, but revealed white multinodular plaques with a diffuse distribution. Histology showed esophageal mucosa with a prominent granular layer and hyperorthokeratotis, in keeping with epidermoid metaplasia. This unusual condition has been linked to esophageal squamous cell carcinoma. Therefore, diagnosis and endoscopic surveillance should be considered.

Heterotopic Gastric Mucosa in Middle Esophagus Complicated with Esophageal Ulcers.

Heterotopic gastric mucosa (HGM) of esophagus, primarily occurring in cervical esophagus, is usually asymptomatic. A healthy woman (mid-40s) with postprandial heartburn was diagnosed with middle esophageal HGM and esophageal ulcers by esophagogastroduodenoscopy. Using 8-channel pH monitoring, a sensor near the HGM area detected postprandial acid phase (pH 3-4), while areas adjacent to the proximal and distal sensors were neutral, suggesting acid secretion from the HGM. A biopsy showed fundic gland tissue expressing H+/K+-ATPase and pepsinogen-I. Oral vonoprazan improved the clinical symptoms and endoscopic findings. This is the first report using 8-channel pH monitoring to diagnose extremely rare middle esophageal HGM.

Glycogenic Acanthosis: An Unusual Cause of Vocal Fold Leukoplakia.

Glycogenic acanthosis is a common benign lesion of the esophagus; however, reports of extra-esophageal manifestations are exceedingly rare. This case represents the first report of laryngeal glycogenic acanthosis found in a living patient, presenting as vocal fold leukoplakia. Glycogenic acanthosis may be considered among the differential diagnoses of conditions presenting as vocal fold leukoplakia. Laryngoscope, 132:1641-1643, 2022.

Acute esophageal necrosis induced by immune checkpoint inhibitors.

A 73-year-old male with a history of chronic obstructive pulmonary disease and stage IV lung adenocarcinoma, being treated with the PD-1 inhibitor nivolumab, presented to the Emergency Room with a two-day history of coffee ground emesis and melena. On examination, he was tachycardic (130 per minute) and hypotensive (95/55 mmHg). Laboratory studies revealed anemia (6.9 g/dl), leukocytosis and hyper-lactatemia (lactate 6.3 mmol/l). Esophagogastroduodenoscopy was performed which showed diffuse circumferential blackish, necrotic-appearing mucosa of the first third of the esophagus. These findings were consistent with a diagnosis of acute esophageal necrosis (AEN). A biopsy of the esophageal mucosa demonstrated fragments of necrotic tissue with predominant lymphocyte infiltration. He was managed with a strict restriction of oral intake, total parenteral nutrition, double-dose proton pump inhibitors and broad-spectrum antibiotics (piperacillin/tazobactam). Despite the measures adopted, the patient presented a progressive clinical deterioration and died of multiple organ failure 12 days after admission.

Possible relationship between esophageal dilatation and severity of M. abscessus pulmonary disease.

OBJECTIVES: Recently, incidence of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD) is increasing worldwide. We aimed to identify factors associated with severity of Mycobacterium abscessus (Mab) pulmonary disease (Mab-PD). METHODS: All patients diagnosed as Mab-PD based on the official ATS/IDSA statement between 2017 January 1 and 2021 July 31 were included (n = 13). We reviewed medical records, bacteriological and laboratory data of the patients. Severity of lung lesions and esophageal diameters in chest CT were quantitatively evaluated. Gaffky score in the sputum was used as airway mycobacterial burden. We explored the factors associated with high CT score and high Gaffky score. RESULTS: Maximum diameter of esophagus (MDE) in severe disease (CT score≧10) was greater than that in milder disease (CT score<10) (18.0±7.9mm, 9.3±3.1mm, respectively, p = 0.01), and MDE was well correlated with CT score (R = 0.69, p = 0.007). MDE in high mycobacterial burden group (Gaffky score ≧5) tended to be greater than that in low mycobacterial burden group (Gaffky score <5) (16.1±6.8mm, 10.1±5.5mm, respectively, p = 0.12), and MDE was well correlated with Gaffky score (R = 0.68, p = 0.009). Lung lesions were bilateral and predominant in middle or lower lobes. CONCLUSIONS: Esophageal dilatation was correlated with severity of Mab-PD and airway mycobacterial burden. Gastroesophageal reflux might be associated with Mab disease progression.