Heterotopic gastric mucosa diagnosed by confocal endomicroscopy.

A 23-year-old woman was referred for a gastroscopy. She had a long history of upper abdominal pain, pyrosis and postprandial fullness without a complete response to proton-pump-inhibitors. She didn’t relate any other relevant symptom or antecedent. Routine blood analysis revealed no abnormalities. The exam was made with a confocal endomicroscope (Pentax EPK-1000, ISC-1000). White light examination found a small flat orange mucosal islet in the cervical esophagus adjacent to the upper esophagic sphincter. It had a diameter of approximately 30mm and beside it there was a 2mm satellite islet. The rest of the exam was normal. The islets were explored with CE after intravenous injection of 5 mL fluoresceine as a contrast agent. It provided images of small glands with round luminal openings and polygonal epithelial cells with cobblestone appearance distinctive of gastric mucosa. Intestinal metaplasia was ruled out since no goblet cells were visualized. The regular architecture of glandular epithelium and the microvasculature as well as the absence of a strong fluoresceine leakage indicated a benign process (figure 1). Heterotopic gastric mucosa diagnosed by confocal endomicroscopy