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Objective:To study the clinical, endoscopic and histological characteristics of heterotopic gastric mucosa in upper esophagus (HGMUE).Methods:A Total of 177 patients who underwent gastroscopy and were diagnosed as having HGMUE at the Endoscopy Center of Wuhan Union Hospital from January 2017 to December 2017 were included in the study. According to the gastroesophageal reflux disease symptom questionnaire (GERD-Q) scores, patients were divided into the HGMUE group (GERD-Q<8, n=101) and GERD+HGMUE group (GERD-Q≥8, n=76). The data of clinical, endoscopic and histological characteristics were analyzed. Results:Among the 177 HGMUE cases, there were 111 males (62.71%) and 66 females (37.29%), 76 (42.94%) with GERD, and 101 (57.06%) without GERD. The most common symptom was continuous clearing throat [54.24% (96/177)], followed by foreign body sensations of throat [48.59% (86/177)], and gastroesophageal reflux symptoms such as heartburn, chest pain, indigestion, acid reflux [48.59% (86/177)]. In the HGMUE group, the occurrence rate of clearing throat was the highest [42.57% (43/101)], then foreign body sensations of throat accounted for 33.66% (34/101), and gastroesophageal reflux symptoms was 27.72% (28/101). In the HGUME+GERD group, the most common symptom was gastroesophageal reflux symptoms [76.32% (58/76)], then clearing throat [69.74% (53/76)] and foreign body sensations of throat [68.42% (52/76)]. Under gastroscopy, 177 heterotopic gastric lesions were found under gastroscopy with orange-red round, oval or elongated island like ones, most of which were flat and a few slightly protruded from the peripheral plane. There were 132 (74.58%) single-lesion cases, 38 (21.47%) 2-lesion, and 7 (3.95%) 3- or more-lesion cases; there were 37 (20.90%) small lesions (maximum diameter <0.5 cm), and 74 (41.81%) median-size lesions (maximum diameter of 0.5-1.0 cm), and 66 (37.3%) larger lesions (maximum diameter >1.0 cm). Among the 30 [16.95% (30/177)] samples of mucosal tissue, 15 [50.00% (15/30)] were mainly cardia gland, 8 [26.67% (8/30)] were mainly pyloric gland, 6 [20.00% (6/30)] were mixed type, and 1 [3.33% (1/30)] was squamous epithelium. In the immunohistochemical test, 20 cases [66.67% (20/30)] showed positive of H +/K +-ATPase, and 10 cases [33.33% (10/30)] were negative. Conclusion:HGMUE is more common in male patients, and may be combined with GERD. Among them, patients with combined GERD are more likely to develop laryngopharyngeal reflux. The heterotopic gastric mucosas lesions are orange-red round, oval or elongated island-like under gastroscopy, and most of them are flat, single and median- or large-sized. Histological types are mostly fundic glands, and H +/K +-ATPase positive is more common. It is speculated that acid secretion may be an important factor leading to throat symptoms.
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Background: Heterotopic gastric mucosa of upper esophagus (HGMUE) earned attention gradually in recent years, and the incidences of esophageal stenosis, esophageal net, dysplasia and adenocarcinoma of upper esophagus caused by HGMUE increased gradually. Aims: To summarize the clinicopathological features of HGMUE patients and analyze its possible risk factors. Methods: A total of 150 HGMUE patients from September 2018 to October 2019 at the People's Hospital of Xinjiang Autonomous Region were collected, and 150 non-HGMUE patients were served as controls. Univariate analysis and multivariate analysis were used to analyze the risk factors of HGMUE. Results: Univariate analysis showed that the incidences of alcohol consumption (P=0.029), Barrett's esophagus (P=0.003) and reflux esophagitis (P=0.001) were significantly increased in HGMUE group than in control group. Unconditional multivariate Logistic regression analysis showed that alcohol consumption, Barrett's esophagus and reflux esophagitis were the independent risk factors of HGMUE (P<0.05). Conclusions: Alcohol consumption, Barrett's esophagus and reflux esophagitis can increase the risk of HGMUE.
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Objective To explore the surgical treatment of cervical and upper thoracic esophageal carcinoma in patients aged 70 or ol-der. Methods A retrospective analysis were made among 68 patients who were over 70 years old, and all the patients have undergone stom-ach esophagus cervical anastomosis through esophageal carcinoma excision and regional lymph node cleaning. Results All the 68 patients have completed the surgery successfully, and they have recoveried well except 3 cases of death. And the main postoperative complication was cardiopulmonary complication and anastomotic fistula. Conclusion Operative treatment of ercervical and upper thoracic esophageal carcino-ma for elderly patients is characterized with highly difficulty and more complications. Stomach esophagus cervical anastomosis through 2-inci-sion with left chest and left neck could simplify the operative procedure, decrease the postoperative complication and improve the curative effect.
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Esophageal small cell carcinoma is a very rare disease. Primary extra-pulmonary small cell carcinoma was reported to account for 4% of primary small cell carcinoma and only 2% of all esophageal malignancy. Because the rate of early distant metastasis is very high, the prognosis is very poor. In Korea, 20 cases were reported. Seventeen cases were located at the mid or lower esophagus and 3 cases were located at the upper esophagus. We have experienced a case of primary upper esophageal small cell cancer, a 65-year-old female with cervical lymph node metastasis, which were diagnosed by endoscopy, open surgical lymph node biopsy and immunohistochemical analysis.