Clinical Endoscopy

Endoscopic Treatment of Jejunal Heterotopic Gastric Mucosa that Caused Recurrent Intussusception: Ke Ryun Ahn, Ja Seol Koo, Hwan Il Kim, Ji Hye Kim, Jee Hyun Lee, Seung Young Kim, Sung Woo Jung, Sang Woo Lee; Clin Endosc 2017;50(6):605-608. Published online October 18, 2017; DOI: https://doi.org/10.5946/ce.2017.026

Heterotopic gastric mucosa (HGM) is a rare anomaly in the small bowel and may be the cause of intussusception when it gets a lead point in the jejunum. All cases of intussusception due to intestinal HGM have been treated with surgical resection. A 5-year-old girl presented with chief complaints of vomiting and abdominal pain for 2 weeks. A computed tomography scan of the abdomen showed intussusception at the proximal jejunal loops. Three air reductions and one saline reduction were attempted without success. She continued to be symptomatic, and endoscopic evaluation was performed. Enteroscopy revealed some variable-sized polypoid mucosal lesions with erosions on the proximal jejunum. Endoscopic mucosal resection was performed using a snare. The resected tissues histologically showed a hyperplastic polyp arising from the HGM. Her symptoms did not recur within 1 year after the treatment. Our case showed that enteroscopy could be useful for the diagnosis and management of jejunal intussusception caused by HGM.

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Journal of Pediatric Gastroenterology and Nutrition.2022; 74(1): 20. CrossRef
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Roxana Merca, Barbara Richter
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Heterotopic Gastric Mucosa Presenting as Lower Gastrointestinal Bleeding: An Unusual Case Report
Syed Muhammad Ali, Ayman Abdelhafiz Ahmed, Leena Amin Hussain Saaid, Gihan Mustafa Kamal Mohamed, Amjad Ali Shah, Mohannad Al-Tarakji, Zia Aftab, Inamulla, Sameera Rashid
Case Reports in Surgery.2019; 2019: 1. CrossRef

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Trial of Argon Plasma Coagulation in Patients with Heterotopic Gastric Mucosa Presenting with Laryngopharyngeal Symptoms: Chan Ik Park, M.D., Jung Ar Shin, M.D., In Su Jung, M.D. and Hyojin Park, M.D.; Korean J Gastrointest Endosc 2008;36(2):74-77. Published online February 27, 2008

Abstract PDF: Heterotopic gastric mucosa in the upper esophagus, in which the inlet patch is a salmon-colored valvet patch, is located mainly below the upper esophageal sphincter. The acid secretion and inflammation from heterotopic gastric mucosa causes laryngopharyngeal symptoms. Generally, the management of heterotopic gastric mucosa depends on the symptoms, and the condition is generally treated by proton pump inhibitor. Recently, it was reported that argon plasma coagulation (APC) is effective when medical treatment fails. A 49-year-old man and a 44-year-old woman with symptoms of globus sensation and hoarseness visited this clinic. An upper gastrointestinal endoscopy showed a flat salmon-colored patch located at the upper esophagus. The former patient failed medical treatment and the latter did not require long term medical treatment. Therefore, the patients were treated with APC, which resulted in an improvement in symptoms. APC treatment may improve the symptoms of patients with heterotopic gastric mucosa of the cervical esophagus. (Korean J Gastrointest Endosc 2008;36:74-77)

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A Case of the Endoscopic Removal of a Duodenal Heterotopic Gastric Mucosa Presenting as a Polypoid Lesion: Sung Hoon Kim, M.D., Seun Ja Park, M.D., Nang Hee Kim, M.D., Ji Hyeon Nam, M.D., Ji Eun Park, M.D., Seo Ryong Han, M.D., Won Moon, M.D., Kyu-Jong Kim, M.D., Moo In Park, M.D. and Min Jung Jung, M.D.*; Korean J Gastrointest Endosc 2007;34(3):146-150. Published online March 30, 2007

Abstract PDF: Ectopic gastric mucosa is known to occur throughout the gastrointestinal tract. Ectopic gastric mucosa in the duodenum is classified into the developmental (heterotopic gastric mucosa) and acquired types (gastric metaplasia). Gastric metaplasia may be present in up to 64% of normal individuals but heterotopic gastric mucosa is quite rare. A heterotopic gastric mucosa in the duodenum may be asymptomatic but can give rise to perforation, hemorrhage, and intestinal obstruction in rare cases. Therefore, periodic endoscopic surveillance is recommended in these cases. Endoscopically, the appearance of a heterotopic gastric mucosa shows a mainly elevated lesion with multiple nodularity. We report a case of 1.5⁓1.2 cm sized polypoid lesion of the duodenum in an asymptomatic 31 year-old man. The mass was resected endoscopically and diagnosed as a heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2007;34:146⁣150)

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Endoscopic Features of Ectopic Gastric Mucosa in the Duodenum: Hae Jung Song, M.D., Ji Hyun Lee, M.D., In Seop Jung, M.D., Su Jin Hong, M.D., Chang Beom Ryu, M.D., Jin Oh Kim, M.D., Joo Young Cho, M.D., Joon Seong Lee, M.D., Moon Sung Lee, M.D., Chan Sup Shim, M.D., Boo Sung Kim, M.D. and So Young Jin, M.D.*; Korean J Gastrointest Endosc 2006;32(4):246-252. Published online April 30, 2006

Abstract PDF: Background
/Aims: The origin of gastric mucosa outside of the stomach may be developmental (heterotopic gastric mucosa) or acquired (gastric metaplasia). The aim of this study was to evaluate the endoscopic features, according to the subtypes, of the gastric mucosa outside the stomach in the duodenum. Methods: A total of 30 consecutive patients who underwent esophagogastroduodenoscopy from January 2002 to August 2004 and who were confirmed histopathologically as having gastric mucosa outside the stomach were retrospectively analyzed. Twenty three patients were males and seven were females. Results: Nine patients had heterotopic gastric mucosa and 21 patients had gastric metaplasia. Seven patients with heterotopic gastric mucosa were asymptomatic and 2 patients had dyspepsia, whereas 21 patients with gastric metaplasia had dyspepsia. The dyspepsia rate showed a significant difference between the two groups (p＜0.001). Endoscopically, the appearance of the heterotopic gastric mucosa tended to resemble area gastricae (p=0.08). However, there were no statistically differences between the two groups for the endoscopic features of the duodenum. Other abnormal lesions in stomach and duodenum appeared more frequently in the gastric metaplasia than in the heterotopic gastric mucosa (p=0.004, p＜0.001). There was no difference in the prevalence of Helicobacter pylori infection between the two groups. Conclusions: There are no specific endoscopic findings to differentiate heterotopic gastric mucosa from gastric metaplasia. The presence of symptoms and the associated gastroduodenal inflammatory lesions were more prominent in the gastric metaplasia compared with the heterotopic gastric mucosa. (Korean J Gastrointest Endosc 2006;32:246⁣252)

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원저 : 식도 위장관 ; 상부식도의 이소성 위점막에 대한 임상적 고찰 ( Original Articles : Esophagus , Stomach & Intestine ; Isolated Heterotopic Gastric Mucosa of the Upper Esophagus ): Korean J Gastrointest Endosc 1997;17(6):737-742. Published online November 30, 1996

Abstract PDF: Background
Isolated heterotopic gastric mucosa of the upper esophagus(HGME), often referred to as inlet patch, is an asyptomatic benign lesion. It may, however, cause retrosternal chest pain and dysphagea, and rarely produce complications such as ulceration and stricture. It may be suspected on characteristic finding of endoscopy, and the diagnosis is usually proved by biposy. We studied several characteristics of HGME. Method: From January 1996 to May 1997, endoscopy was performed on 2000 consecutive patients (1068 male, 932 female). HGME was seen 25 patients(12 male, 13 female) among 2000 patients. Result: Prevalence of HGME is 1.25%. There was no significant difference of the prevalence of HGME between male and female. HGME was presented as a velvety and salmon-pink patch with a distict border from the normally pale squamous cell mucosa of the esophagus, and was seen as multiple lesions in 8 patients among 25 patients. Thirty three locailzed gastric mucosal patches, varying in size 3 mm to 30 mm in the longest diameter, were detected within or just below of upper esophageal spincter in all the twenty five patients. Biopsy specimens taken from the miucosal patches demonstrated gastric mucosa. Among 25 patients with HGME, four patients complained foreign body sensation on throat or heartburn, without other diseases such as GERD, gastritis or peptic ulcer. Conclusion: Further studies of a large scale about pathogenesis, prevalence, and complication of HGME will be required. (Korean J Gastrointest Endosc 17: 737-742, 1997)

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