Giant Heterotopic Gastric Mucosa Presenting as a Polypoid Mass

Abstract

Purpose: Heterotopic gastric tissue in the duodenal bulb (HGTD) is a rare congenital lesion. We present a patient with giant HGTD presenting as a polypoid mass. A 22 year old female with Type II diabetes mellitus presented with epigastric pain and nausea for 2 months. The patient underwent an esophagogastroduodenoscopy (EGD) which showed a 4 cm polypoid laterally spreading mass, occupying one third of the duodenal lumen over the posterior and inferior walls, extending from the bulb to the second portion (Figure 1). Narrow band imaging findings (Figure 2) were suspicious for an adenoma; however, biopsies revealed gastric heterotopia with reactive gastropathy in small bowel mucosal tissue (Figure 3). She was managed conservatively. Heterotopic gastric tissue has been found throughout the alimentary tract. It is usually an incidental finding, but may present with symptoms such as diarrhea, dyspepsia, ulceration, or bleeding. HGTD may occur as a single polypoid mass between 1-2.5 cm in size or as multiple polyps from 3-10 mm in size. Endoscopic examination with biopsy remains the gold standard for diagnosis. Management is usually conservative unless symptoms due to mass effects are present.Figure: Polypoid mass, NBI.Figure: Gastric heterotopia with reactive gastropathy.Figure: Polypoid mass.