AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the...Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection(ESD)is reported.The systematic review was based on a comprehensive search of MEDLINE,EMBASE and Google Scholar.Studies on humans were identified with the term‘heterotopic gastric mucosa in the rectum and/or anus.’Results:The search identified 79 citations,and 72 cases were evaluated comprising the present report.Congenital malformations were observed in 17(24%)patients;rectal duplication accounted for most of the cases.The HGM was located in the anus and perineal rectum in 25 cases(41%)and low,middle and proximal pelvic rectum in 20(33%),five(8%)and 11 cases(18%),respectively.Morphology was nonpolypoid in 37 cases(51%),polypoid in 26 cases(36%)and ulcerated in nine cases(13%).Specific anorectal symptoms were reported by 50(69%)patients of the whole study population,and by 33(97%)of 34 patients≤18 years.Complications were observed in 23 cases(32%).The HGM was excised in 50 cases(83%).Endoscopic resection was performed in 17 cases(34%);resection was piecemeal in five of 12 lesions≥5mm,required argon plasma coagulation in two cases and was associated with residual tissue in two(17%).Intestinal metaplasia and an adenoma with lowgrade dysplasia were described in three adults(4%).Discussion:This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications,mainly in the pediatric population,and a risk of malignancy in adults.Its complete excision should be recommended,and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.展开更多
Heterotopia, also termed as ectopia or choristoma, means the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa in gallbladder is very rare and was first reported by Egyedi in 1934;it is d...Heterotopia, also termed as ectopia or choristoma, means the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa in gallbladder is very rare and was first reported by Egyedi in 1934;it is difficult to make a correct preoperative diagnosis. Our aim is to present this unusual case of heterotopic gastric mucosa together with intestinal metaplasia and mild dysplasia in the gallbladder and to review the literature.展开更多
We describe the case of a 68-year-old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revea...We describe the case of a 68-year-old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revealed an enlarged lymph node-like mass of tissue near the appendix, in the ileocecal mesentery. This mass was removed and was found to be inflamed heterotopic gastric tissue. Although reports of heterotopic gastric tissue in the literature are common, we believe that this case represents the first report of inflamed heterotopic gastric tissue simulating appendicitis.展开更多
AIM:To determine the association between Helicobacter pylori(H.pylori)and globus sensation(GS)in the patients with cervical inlet patch. METHODS:Sixty-eight patients with esophageal inlet patches were identified from ...AIM:To determine the association between Helicobacter pylori(H.pylori)and globus sensation(GS)in the patients with cervical inlet patch. METHODS:Sixty-eight patients with esophageal inlet patches were identified from 6760 consecutive patients undergoing upper gastrointestinal endoscopy prospectively.In these 68 patients with cervical inlet patches, symptoms of globus sensation(lump in the throat), hoarseness,sore throat,frequent clearing of the throat,cough,dysphagia,odynophagia of at least 3 mo duration was questioned prior to endoscopy. RESULTS:Cervical heterotopic gastric mucosa(CHGM) was found in 68 of 6760 patients.The endoscopic prevalence of CHGM was determined to be 1%.H.pylori was identified in 16(23.5%)of 68 patients with inlet patch.53 patients were classified as CHGMⅡ.This group included 48 patients with globus sensation,4 patients with chronic cough and 1 patient with hoarseness.All the patients who were H.pylori(+)in cervical inlet patches had globus sensation.CONCLUSION:Often patients with CHGM have a long history of troublesome throat symptoms.We speculate that disturbances in globus sensation are like non-ulcer dyspepsia.展开更多
An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report ...An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel’s diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel’s diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel’s diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.展开更多
AIM:To demonstrate the feasibility of optical coherence tomography(OCT)imaging in differentiating cervical inlet patch(CIP)from normal esophagus,Barrett'sesophagus(BE),normal stomach and duodenum. METHODS:This stu...AIM:To demonstrate the feasibility of optical coherence tomography(OCT)imaging in differentiating cervical inlet patch(CIP)from normal esophagus,Barrett'sesophagus(BE),normal stomach and duodenum. METHODS:This study was conducted at the Veterans Affairs Boston Healthcare System(VABHS).Patients undergoing standard esophagogastroduodenoscopy at VABHS,including one patient with CIP,one representative patient with BE and three representative normal subjects were included.White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system.The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal(GI)tract.Standard hematoxylin and eosin(H and E)histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data. RESULTS:CIP was observed from a 68-year old male with gastroesophageal reflux disease.The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy.OCT imaging over the CIP region showed columnar epithelium structure,which clearly contrasted the squamous epithelium structure from adjacent normal esophagus.3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus,BE,normal stomach,and normal duodenum bulb.Microstructures,such as squamous epithelium,lamina propria, muscularis mucosa,muscularis propria,esophageal glands,Barrett's glands,gastric mucosa,gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology.These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time. CONCLUSION:We demonstrate in situ evaluation of CIP microstructures using 3D-OCT,which may be a useful tool for future diagnosis and follow-up of patients with CIP.展开更多
文摘AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
基金We thank Mrs.Christel Strohn,and Mrs.Sara Piazza for their assistance in German translation.Author contributions:GI designed the research,FI and GI performed the research,TG,YS,and GC critically reviewed the final version of the paper,and GI and FI wrote the paper.
文摘Background:Heterotopic gastric mucosa(HGM)is the most reported epithelial heterotopia,but it is very rare in the rectum and anus.Methods:The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection(ESD)is reported.The systematic review was based on a comprehensive search of MEDLINE,EMBASE and Google Scholar.Studies on humans were identified with the term‘heterotopic gastric mucosa in the rectum and/or anus.’Results:The search identified 79 citations,and 72 cases were evaluated comprising the present report.Congenital malformations were observed in 17(24%)patients;rectal duplication accounted for most of the cases.The HGM was located in the anus and perineal rectum in 25 cases(41%)and low,middle and proximal pelvic rectum in 20(33%),five(8%)and 11 cases(18%),respectively.Morphology was nonpolypoid in 37 cases(51%),polypoid in 26 cases(36%)and ulcerated in nine cases(13%).Specific anorectal symptoms were reported by 50(69%)patients of the whole study population,and by 33(97%)of 34 patients≤18 years.Complications were observed in 23 cases(32%).The HGM was excised in 50 cases(83%).Endoscopic resection was performed in 17 cases(34%);resection was piecemeal in five of 12 lesions≥5mm,required argon plasma coagulation in two cases and was associated with residual tissue in two(17%).Intestinal metaplasia and an adenoma with lowgrade dysplasia were described in three adults(4%).Discussion:This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications,mainly in the pediatric population,and a risk of malignancy in adults.Its complete excision should be recommended,and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.
文摘Heterotopia, also termed as ectopia or choristoma, means the occurrence of normal tissue in an abnormal location. Heterotopic gastric mucosa in gallbladder is very rare and was first reported by Egyedi in 1934;it is difficult to make a correct preoperative diagnosis. Our aim is to present this unusual case of heterotopic gastric mucosa together with intestinal metaplasia and mild dysplasia in the gallbladder and to review the literature.
文摘We describe the case of a 68-year-old otherwise healthy male who presented to our emergency room with signs and symptoms of acute appendicitis. Exploratory surgery revealed a normal appendix. Further examination revealed an enlarged lymph node-like mass of tissue near the appendix, in the ileocecal mesentery. This mass was removed and was found to be inflamed heterotopic gastric tissue. Although reports of heterotopic gastric tissue in the literature are common, we believe that this case represents the first report of inflamed heterotopic gastric tissue simulating appendicitis.
文摘AIM:To determine the association between Helicobacter pylori(H.pylori)and globus sensation(GS)in the patients with cervical inlet patch. METHODS:Sixty-eight patients with esophageal inlet patches were identified from 6760 consecutive patients undergoing upper gastrointestinal endoscopy prospectively.In these 68 patients with cervical inlet patches, symptoms of globus sensation(lump in the throat), hoarseness,sore throat,frequent clearing of the throat,cough,dysphagia,odynophagia of at least 3 mo duration was questioned prior to endoscopy. RESULTS:Cervical heterotopic gastric mucosa(CHGM) was found in 68 of 6760 patients.The endoscopic prevalence of CHGM was determined to be 1%.H.pylori was identified in 16(23.5%)of 68 patients with inlet patch.53 patients were classified as CHGMⅡ.This group included 48 patients with globus sensation,4 patients with chronic cough and 1 patient with hoarseness.All the patients who were H.pylori(+)in cervical inlet patches had globus sensation.CONCLUSION:Often patients with CHGM have a long history of troublesome throat symptoms.We speculate that disturbances in globus sensation are like non-ulcer dyspepsia.
文摘An inverted Meckel’s diverticulum is a rare gastrointestinal congenital anomaly that is difficult to diagnose prior to surgery and presents with anemia, abdominal pain, or intussusception. Here, we report the case of 57-year-old men with an inverted Meckel’s diverticulum, who was preoperatively diagnosed using double-balloon enteroscopy. He had repeatedly experienced epigastric pain for 2 mo. Ultrasonography and computed tomography showed intestinal wall thickening in the pelvis. Double-balloon enteroscopy via the anal route was performed for further examination, which demonstrated an approximately 8-cm, sausage-shaped, submucosal tumor located approximately 80 cm proximal to the ileocecal valve. A small depressed erosion was observed at the tip of this lesion. Forceps biopsy revealed heterotopic gastric mucosa. Thus, the patient was diagnosed with an inverted Meckel’s diverticulum, and single-incision laparoscopic surgery was performed. This case suggests that an inverted Meckel’s diverticulum should be considered as a differential diagnosis for a submucosal tumor in the ileum. Balloon-assisted enteroscopy with forceps biopsy facilitate a precise diagnosis of this condition.
基金Supported by The VA Boston Healthcare System and NIH grants R01-CA75289-14,to Fujimoto JG and Mashimo HK99-EB010071-01A1,to Zhou C+2 种基金Air Force Office of Scientific Research contract FA9550-10-1-0063,to Fujimoto JGMedical Free Electron Laser Program contract FA9550-10-1-0551,to Fujimoto JGthe MIT/CIMIT Medical Engineering Fellowship,to Tsai TH
文摘AIM:To demonstrate the feasibility of optical coherence tomography(OCT)imaging in differentiating cervical inlet patch(CIP)from normal esophagus,Barrett'sesophagus(BE),normal stomach and duodenum. METHODS:This study was conducted at the Veterans Affairs Boston Healthcare System(VABHS).Patients undergoing standard esophagogastroduodenoscopy at VABHS,including one patient with CIP,one representative patient with BE and three representative normal subjects were included.White light video endoscopy was performed and endoscopic 3D-OCT images were obtained in each patient using a prototype OCT system.The OCT imaging probe passes through the working channel of the endoscope to enable simultaneous video endoscopy and 3D-OCT examination of the human gastrointestinal(GI)tract.Standard hematoxylin and eosin(H and E)histology was performed on biopsy or endoscopic mucosal resection specimens in order to compare and validate the 3D-OCT data. RESULTS:CIP was observed from a 68-year old male with gastroesophageal reflux disease.The CIP region appeared as a pink circular lesion in the upper esophagus under white light endoscopy.OCT imaging over the CIP region showed columnar epithelium structure,which clearly contrasted the squamous epithelium structure from adjacent normal esophagus.3D-OCT images obtained from other representative patients demonstrated distinctive patterns of the normal esophagus,BE,normal stomach,and normal duodenum bulb.Microstructures,such as squamous epithelium,lamina propria, muscularis mucosa,muscularis propria,esophageal glands,Barrett's glands,gastric mucosa,gastric glands, and intestinal mucosal villi were clearly observed with OCT and matched with H and E histology.These results demonstrated the feasibility of using OCT to evaluate GI tissue morphology in situ and in real-time. CONCLUSION:We demonstrate in situ evaluation of CIP microstructures using 3D-OCT,which may be a useful tool for future diagnosis and follow-up of patients with CIP.
