3096 Esophageal Pancreatic Acinar Ectopia—Premalignant or Benign: A Case Report and Brief Literature Review

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INTRODUCTION: Esophageal Pancreatic Acinar Ectopia (EPAE) is a rare incidental endoscopy finding with reported prevalence ranging from 16% to 24% in asymptomatic patients and 3% in patients with Barrette Esophagitis, EPAE has been found in patients as young as 1 day old to incidental autopsy finding. We present a brief literature review and a case of EPAE in distal esophagus with severe dysphagia associated with active inflammation and focal metaplasia. CASE DESCRIPTION/METHODS: A 59 year old male with medical history of Degenerative Joint Disease (DJD), HTN, GERD, and chronic constipation presented to GI clinic with complaint of insidiously worsening dysphagia to solid food of 4 months duration. He also endorsed 30-pound weight loss and denied any other associated symptoms. He has significant family history of colon cancer. He is a current smoker with 10 pack years. His medications include Hydrochlorothiazide, Amlodipine, Lisinopril, Atorvastatin and Nexium. Physical exam revealed no significant findings in all systems, including gastrointestinal. Most recent labs including hematology and chemistry were within normal limits. An endoscopy was performed which revealed slightly irregular gastroesophageal (GE) junction, 5 × 3 cm pink rubbery mass at the GE junction which was biopsied, and an irregular gastric mucosa with biopsy obtained. The biopsy obtained from the GE junction revealed intestinal metaplasia and pancreatic acinar type tissue with no dysplasia while the biopsy from the stomach revealed numerous h-pylori, intestinal metaplasia with active chronic gastritis. At follow up appointment 2 weeks after the endoscopy, patient reported complete resolution of dysphagia and improvement in constipation. DISCUSSION: A review of the literature showed that Esophageal Pancreatic Acinar Ectopia (EPAE) is often an incidental finding, with prevalence in up to 24 percent of all adults and no associated symptoms in most. It has however been associated with symptoms like epigastric pain, hemoptysis, odynophagia, dysphagia, and pathologies like esophageal atresia, anaplastic carcinoma, pancreatitis, IPMN, and squamous cell carcinoma. EPAE has been documented in neonates making congenital etiology most plausible. Our case bolsters the knowledge that dysphagia, which is the most common presenting symptom in EPAE, is likely due to mass effect and our literature review revealed that most pathologies known to pancreatic tissue are possible in EPAE.