Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review

Federico Iacopini; Takuji Gotoda; Walter Elisei; Patrizia Rigato; Fabrizio Montagnese; Yutaka Saito; Guido Costamagna; Giampaolo Iacopini

doi:10.1093/gastro/gow006

Heterotopic gastric mucosa in the anus and rectum: first case report of endoscopic submucosal dissection and systematic review

Gastroenterol Rep (Oxf). 2016 Aug;4(3):196-205. doi: 10.1093/gastro/gow006. Epub 2016 Apr 21.

Authors

Federico Iacopini¹, Takuji Gotoda², Walter Elisei¹, Patrizia Rigato³, Fabrizio Montagnese¹, Yutaka Saito⁴, Guido Costamagna⁵, Giampaolo Iacopini⁶

Affiliations

¹ Gastroenterology and Endoscopy Unit, Ospedale S. Giuseppe, Albano L., Rome, Italy.
² Division of Gastroenterology and Hepatology, Nihon University School of Medicine, Tokyo, Japan.
³ Pathology Unit, Ospedale S. Giuseppe, Marino, Italy.
⁴ Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
⁵ Digestive Endoscopy Unit, Policlinico Gemelli, Catholic University, Rome, Italy and.
⁶ Gastroenterology Clinic, Rome, Italy g.iacopini@libero.it.

Abstract

Background: Heterotopic gastric mucosa (HGM) is the most reported epithelial heterotopia, but it is very rare in the rectum and anus.

Methods: The first case of an asymptomatic adult male with a large nonpolypoid HGM in the low rectum underwent complete resection by endoscopic submucosal dissection (ESD) is reported. The systematic review was based on a comprehensive search of MEDLINE, EMBASE and Google Scholar. Studies on humans were identified with the term 'heterotopic gastric mucosa in the rectum and /or anus.'

Results: The search identified 79 citations, and 72 cases were evaluated comprising the present report. Congenital malformations were observed in 17 (24%) patients; rectal duplication accounted for most of the cases. The HGM was located in the anus and perineal rectum in 25 cases (41%) and low, middle and proximal pelvic rectum in 20 (33%), five (8%) and 11 cases (18%), respectively. Morphology was nonpolypoid in 37 cases (51%), polypoid in 26 cases (36%) and ulcerated in nine cases (13%). Specific anorectal symptoms were reported by 50 (69%) patients of the whole study population, and by 33 (97%) of 34 patients ≤ 18 years. Complications were observed in 23 cases (32%). The HGM was excised in 50 cases (83%). Endoscopic resection was performed in 17 cases (34%); resection was piecemeal in five of 12 lesions ≥15 mm, required argon plasma coagulation in two cases and was associated with residual tissue in two (17%). Intestinal metaplasia and an adenoma with low-grade dysplasia were described in three adults (4%).

Discussion: This systematic review shows that the HGM in the rectum and anus may be associated with specific rectal symptoms and serious complications, mainly in the pediatric population, and a risk of malignancy in adults. Its complete excision should be recommended, and the ESD can overcome the technical limits of conventional endoscopic snare resection and avoid unnecessary surgery.

Keywords: endoscopic submucosal dissection; heterotopic gastric mucosa; rectum; review.

Publication types

Review