Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review
| Autor: | Guido Costamagna, Walter Elisei, Federico Iacopini, Fabrizio Montagnese, Giampaolo Iacopini, Patrizia Rigato, Yutaka Saito, Takuji Gotoda |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Adenoma Settore MED/18 - CHIRURGIA GENERALE review Rectum Argon plasma coagulation Asymptomatic 03 medical and health sciences 0302 clinical medicine medicine rectum endoscopic submucosal dissection heterotopic gastric mucosa Review Articles medicine.diagnostic_test business.industry Gastroenterology Intestinal metaplasia Anus medicine.disease digestive system diseases Surgery Endoscopy medicine.anatomical_structure Dysplasia 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology medicine.symptom business |
| Zdroj: | Gastroenterology Report |
| ISSN: | 2052-0034 |
| Popis: | 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 ≥15 mm, required argon plasma coagulation in two cases and was associated with residual tissue in two (17%). Intestinal metaplasia and an adenoma with low-grade 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. |
| Databáze: | OpenAIRE |
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