case_images: PMC6626471_01
case_images: PMC6626471_02
case_images: Oesophagogastroduodenoscopy (EGD) on admission. (A) EGD demonstrated dilation in the proximal and mid portions of the oesophagus. (B) EGD showed a narrowed lower oesophageal sphincter. (C) No masses were seen on retroflexed views of the stomach. Gastric biopsies showed focal intestinal metaplasia.
case_images: bmjgast-2019-000284f01.jpg
case_images: PMC6626471_02_bmjgast-2019-000284f01.jpg
case_images: F1
case_images: Repeat EGD performed on day 2 of admission showed similar findings to the outside hospital, including oesophageal dilation in the proximal and mid portions with a 'tight' LES and blanching of the GE junction mucosa:a release was felt as the scope passed into the stomach (popping sensation) (figure 1A,B). Biopsies taken from the GE junction showed focal intestinal metaplasia, yet again no signs of dysplasia/malignancy (figure 1C).
case_images: PMC6626471_03
case_images: Day 10 oesophagogastroduodenoscopy for pneumatic dilation using a 30 mm Rigiflex balloon. The stomach had thickened folds with pale mucosa. Biopsies consistent with mild chronic inflammation but no evidence of malignancy.
case_images: bmjgast-2019-000284f02.jpg
case_images: PMC6626471_03_bmjgast-2019-000284f02.jpg
case_images: F2
case_images: With the above negative findings, the patient underwent pneumatic dilation with a 30 mm Rigiflex balloon (figure 2).
case_images: Day 16 oesophagogastroduodenoscopy (EGD). (A) EGD showed thickening of the distal oesophagus with narrowing of the lower oesophageal sphincter necessitating a paediatric scope to traverse the narrowing. (B) The gastric folds were thickened with areas of white streaks and the stomach was not easily distensible. Biopsies were consistent with poorly differentiated adenocarcinoma.
case_images: bmjgast-2019-000284f03.jpg
case_images: PMC6626471_03_bmjgast-2019-000284f03.jpg
case_images: F3
case_images: This time, the area could not be traversed with the standard upper endoscope, a significant difference from the prior endoscopy (figure 3A). A paediatric scope was then used to pass into the stomach revealing significantly thickened, hypertrophied gastric folds in the body, with biopsies showing poorly differentiated adenocarcinoma consistent with her primary bladder cancer (figure 3B).
case_images: PMC6626471_04