Large heterotopic gastric mucosa and a concomitant diverticulum in the rectum:Clinical experience and endoscopic management

Heterotopic gastric mucosa(HGM) in the rectum is an extremely rare clinical entity which may be missed or misdiagnosed due to a lack of knowledge.In the present study,a 14-year-old girl visited our hospital due to a 5-year history of repeated hematochezia.Colonoscopy showed a solitary superficial depressed lesion approximately 5 cm in size and a concomitant 1.5 cm deep diverticulum in the rectum.Histological examination of the endoscopic biopsy showed typical ectopic gastric mucosa in the depressed lesion and inside the diverticulum.Narrow band imaging further confirmed the histological results.Endoscopic ultrasound indicated that the lesion originated from the mucosal layer,and partially involved the submucosal layer.Endoscopic submucosal dissection was performed in this patient due to the large size and shape of the lesion.No bleeding,perforation or other adverse events were observed.The presence of HGM in the diverticular cavity greatly increased the surgical difficulty.A literature review was also carried out in our study.

Prevalence,histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients

AIM: To determine the prevalence, demographic, clinical and histopathologic features of heterotopic gastric mucosa (HGM) in Chinese patients.

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).

Perforated jejunal ulcer associated with gastric mucosa in a jejunal diverticulum

Jejunal diverticula are rare and subsequent complications even more so. The usual small bowel diverticulum encountered by general surgeons is a Meckel's. These are embryological remnants of the vitello-intestinal duct and are on the anti-mesenteric surface of the terminal ileum. They may contain heterotopic gastric or pancreatic mucosa. Herein we explore the case of a young girl who presented with features of peritonitis secondary to a complication from a jejunal diverticulum. The case, pathology, complications and treatment of jejunal diverticulosis and heterotopic gastric mucosa in the jejunum are explored.

Extraintestinal heterotopic gastric tissue simulating acute appendicitis

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.

Is there an association between Helicobacter pylori in the inlet patch and globus sensation?

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.

Heterotopic gastric mucosa in the anus and rectum:first case report of endoscopic submucosal dissection and systematic review

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.

Heterotopic gastric mucosa with mild dysplasia in the gallbladder

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.

Issues and controversies in esophageal inlet patch

The proximal esophagus is rarely examined,and its inspection is often inadequate.Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus,a region in which their prevalence is likely underestimated.Various studies have reported correlations between these esophageal marks with different issues such as Barrett’s esophagus,but these findings remain controversial.Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance.Unfortunately,the limited clinical data and statistical analyses make reaching any conclusions difficult.It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms,diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers.Due to its potential underdiagnosis,there are no consensus guidelines for the management and follow up of inlet patches.This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.

Diagnosis and endoscopic treatment of esophago-bronchial fistula due to gastric heterotopy

Heterotopic gastric mucosa patches are congenital gastrointestinal abnormalities and have been reported to occur anywhere along the gastrointestinal tract from mouth to anus.Complications of heterotopic gastric mucosa include dysphagia,upper gastrointestinal bleeding,upper esophageal ring stricture,adenocarcinoma and fistula formation.In this case report we describe the diagnosis and treatment of the first case of esophago-bronchial fistula due to heterotopic gastric mucosa in mid esophagus.A 40-year old former professional soccer player was referred to our department for treatment of an esophago-bronchial fistula.Microscopic examination of the biopsies taken from the esophageal fistula revealed the presence of gastric heterotopic mucosa.We decided to do a non-surgical therapeutic endoscopic procedure.A sclerotherapy catheter was inserted through which 1 mL of ready to use synthetic surgical glue was applied in the fistula and it closed the fistula opening with excellent results.

Cervical inlet patch-optical coherence tomography imaging and clinical significance

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.

Inverted Meckel's diverticulum preoperatively diagnosed using double-balloon enteroscopy

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.

十二指肠胃黏膜异位症的内镜表现及临床特点

目的十二指肠胃黏膜异位(HGM)是一种较少见的先天性胚胎残余病变,患者多表现为功能性消化不良(FD)或慢性胃炎症状,临床上容易漏诊。该实验通过对135例十二指肠球部胃黏膜异位症病例的分析,探讨其临床诊疗特点。方法有FD或慢性胃炎症状行胃镜检查患者,发现十二指肠HGM病变行内镜切除并作病理检查,分析幽门螺杆菌(Hp)感染情况,并采用Glasgow评分对治疗前后进行症状评分。结果 4 650例胃镜检查患者中,发现十二指肠HGM患者134例,胃镜检出率为2.9%。患者主要表现上腹隐痛不适、反酸或腹胀等症状。按罗马Ⅲ标准分类,其中符合餐后不适综合征(PDS)者92例(69.2%)、上腹痛综合征(EPS)43(31.8%)。内镜检查发现,十二指肠HGM主要位于十二指肠球部(93.3%),降段较为少见(6.7%)。形态上主要分为4种类型:以多发结节样隆起最为多见,占57%;其次为单发息肉或多发颗粒状隆起(34.1%)。少见的还有溃疡及肿块型,分别占6.7%和2.2%。这两型由于形态不典型,极易误诊为消化性溃疡或肿瘤。超声内镜(EUS)对不典型的十二指肠HGM病变的鉴别诊断有意义,表现为黏膜下层低回声光团,内有无回声区,但这些特征有时也易误诊为异位胰腺。内镜下切除十二指肠HGM对症状改善有帮助。结论十二指肠HGM是部分FD或慢性胃炎症状反复发作的原因,内镜下治疗HGM可有效改善患者的症状。

食管上段异位胃黏膜的组织学特点及临床意义

目的观察食管上段异位胃黏膜(heterotopic gastric mucosa in upper esophagus,HGMUE)的组织学特点以及内镜下表现,研究患者各相关临床症状与HGMUE泌酸功能之间的联系。方法分析40例普通内镜下诊断为HGMUE的患者的临床表现、NBI内镜以及共聚焦激光显微内镜(confocal laser endomicroscopy,CLE)特点,采用透射电镜、HE、免疫组化观察其病理学特征。结果 40例患者中,平坦型38例(95%),隆起型2例(5%),病变形态有椭圆形18例(45%)、圆形9例(22.5%)、不规则岛状7例(17.5%)、条索状6例(15%);NBI内镜下,可清楚区分病变区域与周围正常食管黏膜,小凹形态以管状(92.5%)为主,未发现表面微血管扩张变异;CLE扫描腺管开口呈胃底型27例,非胃底型13例,结合HE病理诊断,符合率为92.5%,有不同程度的荧光素钠渗出;透射电镜显示细胞超微结构与正常胃黏膜无明显差异,HE染色胃底型腺体28例(70%),非胃底型腺体12例(30%);免疫组化结果显示,胃底型腺体中质子泵、胃蛋白酶原Ⅰ、胃蛋白酶原Ⅱ表达均为阳性;相关临床症状中除胸骨后疼痛与壁细胞有关外(P<0.05),其余症状壁细胞均无统计学差异(P>0.05)。结论 HGMUE患者病理分型以胃底型为主,此种异位胃黏膜可能有分泌胃酸及胃蛋白酶的能力,与患者胸骨后疼痛的症状相关;NBI内镜及CLE对于HGMUE的诊断比普通内镜可能具有更好的分辨效果及价值。

食管胃黏膜异位检出率的影响因素分析及其对食管检查质量评价的研究

目的观察食管胃黏膜异位(heterotopic gastric mucosa of the esophagus,HGME)检出率的影响因素,探讨其作为食管内镜检查质量评估指标的可能性。方法对接受胃镜检查者进行前瞻性临床调查研究,患者在行内镜检查时,记录患者是否行无痛胃镜、内镜操作医师经验级别、食管观察时间等。分析HGME检出率及其影响因素。结果 2 000例检查者中共检出HGME 194例,HGME检出率为9.7%,总共发现HGME 251处,平均HGME数为0.126(251/2 000),平均阳性HGME数为1.294(251/194)。HGME组医师经验级别高于非HGME组,使用无痛胃镜率高于非HGME组,食管观察时间长于非HGME组,差异有统计学意义(P<0.05)。医师经验不同HGME检出率差异有统计学意义(P<0.05),随医师经验增加HGME检出率有增高的趋势。相关性分析结果显示,医师经验和HGME检出率呈正相关(rs=0.685,P=0.001)。结论 HGME检出率的高低与内镜检查医师经验、麻醉状态下检查、食管观察时间有关。HGME的检出率可作为评价食管检查质量的指标。

食管胃黏膜异位内镜检出率的影响因素分析

目的探讨影响食管胃黏膜异位(HGME)内镜检出率的影响因素,以提高HGME的内镜检出率。方法回顾性分析2018年1月-2018年12月在柳州市人民医院行胃镜检查的患者19948例。记录患者年龄、性别、胃镜检查方式、胃镜检查模式和胃镜医师级别等,分析HGME检出率的影响因素。结果检出HGME 282例,总检出率为1.41%(282/19948)。不同组别发现的HGME病例数如下:无痛胃镜组226例(1.53%),普通胃镜组56例(1.07%);NBI组89例(3.06%),普通白光组193例(1.13%);按胃镜医师级别分组,住院医师及低年资主治医师组37例(0.89%),高年资主治医师组93例(1.48%),副主任医师及以上组152例(1.59%)。经统计学分析,胃镜检查方式、胃镜检查模式和医师分级对HGME检查率均有影响(P<0.05),而患者年龄和性别对HGME检出率无明显影响。结论HGME检出率与胃镜检查方式、胃镜检查模式和医师分级相关,无痛胃镜、NBI模式、内镜医师经验的积累均能明显提高HGME的检出率。

无痛胃镜对食管上段胃黏膜异位的诊断价值

目的评价无痛胃镜对食管上段胃黏膜异位（HGMUE）的诊断价值。方法接受胃镜检查者8965例，按检查方式分为无痛胃镜组4328例和普通胃镜组4637例，对2种方式HGMUE的诊断率、内镜特点和临床表现进行比较分析。结果普通胃镜组4637例，检出HGMUE14例，诊断率为0．30％；无痛胃镜组4328例，检出HGMUE34例，诊断率为0．79％，明显高于普通胃镜组，差异有统计学意义（P〈0．05）。无痛胃镜组距门齿15～17cm范围内的病灶以及直径〈1cm的病灶检出率明显高于普通胃镜组，差异有统计学意义（P〈0．05）。结论无痛胃镜不仅能减少患者痛苦，更能提高HGMUE的诊断率，真实地反映HGMUE的发病情况，大大减少漏诊率，特别适于上食管近段及小的HGMUE病灶。

内镜检查对食管胃黏膜异位的诊断意义

目的:分析食管胃黏膜异位症(HGM)内镜下表现特征及其病理学特点,探讨幽门螺杆菌(H pylori)与HGM的关系.方法:2007-01/2008-12我院门诊HGM患者27例,均经病理组织学证实,行电子胃镜检查,进镜后观察食管黏膜,行黏膜活检病理检查,以及快速尿素酶检验,阳性者诊为H pylori感染.结果:内镜检查发现异位灶共34处,其中单病灶占77.8%,多沿长轴纵行分布;双病灶占18.5%,多呈对吻性;3个病灶占3.7%.病变呈椭圆形或圆形,橘红色或深红色黏膜区,与周围的灰白色正常食管黏膜分界清楚,直径为0.5-2.5cm.1例伴有0.75cm大小圆形浅溃疡.病理检查显示可见胃柱状上皮,含有壁细胞和主细胞,其中51.9%见炎性细胞浸润.37%H pylori检测呈阳性,在HGM伴有慢性炎症及肠上皮化生者中35.3%H pylori呈阳性.结论:HGM存在H pylori感染,但感染与病变程度无明确相关性,内镜检查技术的完善及活检的充分和准确,对于HGM具有重要的确诊意义.

十二指肠球部胃黏膜异位的内镜与病理特点

目的探讨十二指肠球部胃黏膜异位的内镜与病理特点。方法回顾性分析2003年10月-2012年10月在我院经病理证实的102例十二指肠球部胃黏膜异位的患者临床、内镜资料。结果异位病灶位于球腔前壁较多见,根据内镜下表现可分为三型,颗粒样增生35例,平坦隆起型20例,息肉样增生47例。病理提示固有层可见胃体腺,部分可见胃底腺及幽门腺。结论内镜下分型以息肉样增生最多见,单纯内镜诊断符合率低,组织病理学检查是确诊本病的主要手段。

氩离子凝固术治疗食管上段胃黏膜异位19例分析

目的探讨氩离子凝固术(APC)对食管上段胃黏膜异位的治疗作用。方法对19例经过病理证实的食管上段胃黏膜异位患者进行氩离子凝固术治疗,术后3、6、12个月随访,对其疗效及安全性进行评价。结果19例患者经APC治疗3个月后复查胃镜,17例达到完全的鳞状上皮再生,2例患者均为异位黏膜面积较大,经过再次APC治疗随访未发现复发,所有病例未发生出血、穿孔等严重不良反应。结论APC治疗食管上段胃黏膜异位是一种疗效确切、安全性好、不良反应少的方法。