E0216 - Epidermoid Metaplasia in the Proximal Esophagus

Brian M. Fung, MD, Claire Faulkner, BA, Joseph David, MD
University of Arizona College of Medicine, Phoenix, AZ

Introduction: Esophageal epidermoid metaplasia is a rare condition characterized by orthokeratotic hyperkeratosis and the development of a prominent granular layer within the esophageal squamous epithelium, resulting in the formation of well-demarcated white plaques resembling the epidermis of the skin.

Case Description/Methods: A 65-year-old female presented with a two-year history of intermittent dysphagia to solids and pills. Her dysphagia was sensed in the suprasternal notch. She denied symptoms of acid reflux or weight loss. Her past medical history included vulvar lichen planus and hypertension. Her medications included topical steroids and metoprolol. She denied a history of smoking or alcohol use, and family history was unremarkable for gastrointestinal illnesses. An esophagogastroduodenoscopy (EGD) was performed, which revealed a circumferential area of whitish mucosa adjacent to an inlet patch in the upper third of the esophagus with mild stenosis. This was biopsied and dilated with 36 and 39 French bougies. Biopsies of the abnormal-appearing mucosa were read as normal squamous tissue. She was started on omeprazole 20 mg twice daily but reported no improvement. An EGD was repeated two months later, which revealed little change endoscopically with biopsies again being read as normal. As the patient remained symptomatic on proton pump inhibitor therapy, she was started on viscous budesonide 1.5 mg twice daily for three months which resulted in significant improvement of dysphagia. At one year follow up, off budesonide, she reported mild recurrence of dysphagia, but not nearly as bad as it had previously been. Repeat EGD revealed similar whitish mucosa in the upper esophagus and the inlet patch. Biopsies of the upper esophagus now revealed epidermoid metaplasia. She declined further treatment with budesonide as her symptoms were manageable.

Discussion: Epidermoid metaplasia is an uncommon finding in the esophagus. While the pathophysiology of this condition is unknown, the majority of patients with this condition are middle aged or elderly, drink alcohol and/or use tobacco, and report symptoms of dysphagia. It is most commonly found in the middle to distal esophagus; however, in our patient, the finding was located in the proximal esophagus. Due to a possible association with esophageal squamous dysplasia and carcinoma in adjacent mucosa, patients with this condition should undergo short interval follow up with directed biopsies at the endoscopic areas of leukoplakia as well as surrounding mucosa.


Disclosures:


Brian M. Fung, MD, Claire Faulkner, BA, Joseph David, MD. E0216 - Epidermoid Metaplasia in the Proximal Esophagus, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.