Endosonographic and Clinicopathological Features of polypoid lesions at Gastroesophageal Junction Associated with Reflux Esophagitis

Background and Aims: Gastric polyps at gastroesophageal junction (GEJ) are found incidentally when EGD is performed for GERD. The pathologic nature and malignant potential of superficial protruding lesions are difficult to be confirmed by either EUS or EGD biopsy. The study was to evaluate the EUS features and clinicopathologic outcomes of GEJ polypoid lesions. Patients and methods: From Jul 1999 to Dec 2005, total 65 patients with reflux esophagitis and polypoid lesions (>5mm) at GEJ are referred for EUS. EUS pictures/video review was conducted of GEJ superficial polypoid lesions, excluding submucosal tumors. All 48 GEJ polypoid lesions were scanned by Olympus UM-2R/3R miniprobes and water-filling method, followed by 17 endoscopic resections (4 polypectomy and 13 EMRC) on 16 patients and 32 biopsies for histologic confirmation Results: 48 pts (32 male, 16 female) had mean age 51.2 years (range 19–89 years), and average size by EUS measurement, 9.02+/-4.5mm (4 to 25mm). The final pathology of GEJ polyps: 42 non-neoplastic (25 inflammatory, 17 hyperplastic), 6 neoplastic polyps (3 adenoma and 3 adenocarcinoma. The EUS features of non-neoplastic polyps are ill-defined margin (36/42), hypoechoic mucosal thickening/folding (38/42), central hyperechoic submucosal core (25/42); However that of neoplastic lesions: well-defined margin (5/6), irregular mucosal surface with ulcer/depression (4/6), deep infiltration on muscular layer (1/6). All three adenocarcinoma and one adenoma with severe dysplasia received EMRC, size/age: 13.2mm/84, 12mm/89, 10mm/77, 16.8mm/76 respectively. There is no malignant change on other GEJ polyps from endoscopic follow-up in 2.9yrs. Conclusions: inflammatory and hyperplastic polyps at GEJ are frequently found and predicted by EUS on GERD. Advanced Endoscopic resection methods (eg. EMR) could be applied safely on patient (>70 yr), polyp size (>10mm) and neoplastic polyps.