Adenocarcinoma arising from ectopic gastric mucosa in an esophageal inlet patch: treatment by endoscopic submucosal dissection.

A 62-year-old man was referred for further diagnostic work-up and treatment of a focal lesionwithin a large area of ectopic gastric mucosa (EGM) in the proximal esophagus. The lesion was diagnosed during an upper gastrointestinal endoscopy which had been performed because of suspected gastroesophageal reflux disease. We confirmed a semicircumferential area of ectopic gastric mucosa reaching from 16 to 19cm from the incisors and containing a 7-mm nodular lesion (●" Fig.1a). Narrow band imaging (NBI) combined with magnifying endoscopy revealed an irregular surface pattern and irregular vascular pattern of the nodule, and also the regular surface pattern of the surrounding flat mucosa (●" Fig.1b). Staining with acetic acid confirmed the irregular surface pattern (●" Fig.1c). These findings were highly suspicious of an early cancer and biopsy of the nodule showed adenocarcinoma arising from ectopic gastric mucosa. The lesion was resected by endoscopic submucosal dissection (ESD) using the hook-knife (KD-620LR; Olympus, Tokyo, Japan) (●" Fig.2). Resection was performed with the patient under general anesthesia and his further course was uneventful. Histological examination showed en bloc R0 resection of a mucosal adenocarcinoma (pT1a L0 V0 G2 R0) arising within ectopic gastric mucosa (●" Fig.3). Because Fig.2 Results of endoscopic submucosal dissection (ESD) of early adenocarcinoma arising in an esophageal inlet patch. a Resection ulcer in the proximal esophagus after ESD. b Resection specimen, 30×25mm in diameter. Fig.1 Endoscopic findings of early adenocarcinoma arising from ectopic gastric mucosa in the proximal esophagus in a 62-year-old man. aWhite light endoscopy shows a semicircumferential area of ectopic gastric mucosa with a nodule. b Narrow band imaging (NBI) combined with magnifying and underwater endoscopy shows the irregular surface and irregular vascular pattern of the nodule. c Staining with acetic acid confirms the irregular surface pattern of the lesion and the regular surface pattern of the surrounding mucosa. Cases and Techniques Library (CTL) E337