Video Tip: Diagnosing Heterotopic Gastric Mucosa-Diagnosing Heterotopic Gastric Mucosa

Video Transcription

This ASG video tip is brought to you by an educational grant from Braintree, a part of Cibela Pharmaceuticals, makers of SUTAB.  This is a lesion that's in the distal rectum, which is the usual location of it when it's found in the colon. It is quite rare.  I will tell you right now that this is not a tubular adenoma or a sessile serrated lesion. This was seen in a 42-year-old man who had some nonspecific rectal symptoms.  Occasionally, these are associated with more significant rectal symptoms, including rectal bleeding.  There has been some association of this lesion with the development of cancer in the rectum. You can see that we're going to resect it.  I have had several of these referred to me and have found a few myself. They come in a variety of shapes.  They can either be flat, like this one, or they can have a bit of bulk to them, be more polyploid.  I've seen one that had a significant sort of valley or depression in it that made it quite difficult to remove, and I ultimately referred for transanal resection.  In general, these should be removed when they are identified. Distal rectum, and the question is, what is this lesion?  This is heterotopic gastromucosa in the distal rectum. Gastroenterologists are familiar with heterotopic gastromucosa in the esophagus and duodenum, especially the bulb,  and it's much more common there, but it can occur in the colon. When it does, it's just pretty much invariably, in my experience, as well as in the literature,  it is in the distal rectum. It can have a variety of appearances, including polypoid. In my experience, I have resected all of them, typically endoscopically,  although, as I mentioned in one case, by surgery, and that's because there is an association with symptoms. Clearly, when it's discovered in a very young person,  it's most often been discovered because the patient is presented with symptoms. It has been reported in pediatric patients producing symptoms, so that's one reason to remove it.  Also, the suggestion, at least, that there could be a risk of cancer, although I think that's less well established.  ♪♪

Video Summary

This video tip, sponsored by Braintree, discusses a rare lesion found in the distal rectum. It is not a tubular adenoma or a sessile serrated lesion and is often associated with rectal symptoms, including bleeding. The lesion, known as heterotopic gastromucosa, can have various shapes and is typically resected when identified. Although more common in the esophagus and duodenum, it is found in the distal rectum and has been reported in pediatric patients. Removal is recommended due to symptoms and potential cancer risk, although the association is not well-established.

Keywords

video tip

Braintree

rare lesion

distal rectum

heterotopic gastromucosa