[High-grade dysplasia as a result of gastric metaplasia]

Barrett's esophagus (BE) is an acquired condition in which the normal esophageal squamous epithelium is replaced by columnar epithelium. It has been long pointed out that columnar metaplasia should be of intestinal goblet cells in order to define the BE, because intestinal metaplasia (IM) has been considered as the only conferring oncogenic risk, therefore having pre-neoplastic potential However, the definition ofBE restricted to the presence of IM has been widely discussed and currently constitutes a debated topic. We describe the case ofa patient with gastroesophageal reflux disease and high-grade dysplasia in the distal esophagus. Endoscopic mucosal resection ofthe lesion was performed using the Duette technique in one piece. The pathological study reported high-grade dysplasia with morphological features consistent with gastric metaplasia, without IM. The patient was treated with a proton pump inhibitor (PPI) and developed a disseminated dermatosis. He was evaluated by a dermatologist who diagnosed lichenoid dermatitis probably due to the PPI. The PPI was replaced by a H2 inhibitor and the skin lesions improved. The endoscopic control showed no residual tissue in the site of resection and the biopsies of the scar were negative for dysplasia and gastric metaplasia.