HOME
Return to Table of Contents
165 MID-ESOPHAGEAL GASTRIC METAPLASIA AFTER LYE INGESTION: A CASE AND IMPLICATIONS TO ESOPHAGEAL HEALING SC Grover, R Saravanan, G May, G Kandel, PP Kortan, NE Marcon Lye ingestion is a known cause of long term esophageal complications, which can present years after ingestion. Patients with caustic ingestions are not only at high risk for esophageal squamous cell carcinoma; other anatomical changes including strictures and fistulae have been reported as late as 22 years after the ingestion. The mechanisms behind the development of these anatomical changes are still uncertain.
Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario
We report the case of a 26 year old woman who presented 3 years after ingestion of 50 cc of an alkali containing oven cleaner (Easy-Off, Reckitt & Colman, Wayne NJ). Her initial symptoms were dysphagia to solids and liquids. Esophagoscopy initially revealed a mid-esophageal stricture which could not be traversed even with an ultra-slim gastroscope. Barium swallow revealed a tight stricture of 12 cm length in the mid-esophagus. This was progressively dilated, initially under fluoroscopic guidance, using Savary-Guillard bougienage. Biopsies of the esophagus at the area of stricture showed evidence of gastric columnar epithelium in the absence of intestinal metaplasia or dysplasia. Endoscopies performed six years after presentation confirm gastric-appearing mucosa in the same area, and follow-up biopsies confirm the same pathology. The patient progressed to develop a chronic stricture that required repeat bougienage for symptom control, but never showed evidence of dysplasia in biopsy specimens.
The pathogenesis of benign and malignant complications of lye ingestion is uncertain. Based on this case, we hypothesize that differences in patterns of re-epithelialization of the affected area predispose to different complications. Re-epithelialization with gastric mucosa may be protective against squamous cell carcinomas, but may still lead to other anatomical complications including strictures and fistulae; conversely, healing with squamous mucosa may predispose toward squamous cell carcinoma. This may be useful in stratifying patients with respect to complication risk after lye ingestion.