A 58-year-old man was admitted to the endoscopy unit for upper GI endoscopy. The patient gives a history of operated right-side colonic carcinoma (cecal mass) followed by chemotherapy. Follow-up with PET/ CT this month revealed thickening at the GEJ junction and small reactive paraesophageal lymph nodes. No upper or lower GI complaint. Upper digestive endoscopy was done and revealed. GEJ mass and histopathology revealed adenocarcinoma.
Is it primary GEJ cancer or metastasis from colon carcinoma?
Video1: in this video, you can see the inflammation (circular inflammatory patches) in the body and antrum of the stomach. But you cannot see the lesion or mass in the subcardia or GEJ.
It is mandatory to do retroflection in the fundus and observe the GEJ.
Furthermore, it is mandatory to make a slow removal with a good inspection of the GEJ junction and everywhere through the entire esophagus to the oropharynx.
Video2: This video shows a mass in the GEJ junction, methylene blue was applied.
What is your endoscopic diagnosis?
Video3: in this video methylene blue was applied to the body and antrum of the stomach. After washing, multiple biopsies were taken for histopathology.
Video4: in this video, multiple biopsies were taken for histopathology.
Video6: in this video, multiple biopsies were taken from the GEJ in the forward position. You can notice the difficulty in taking biopsies using this position.
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