Bile reflux gastritis cystica profunda: a case report
A 50-year-old man presented with intermittent abdominal fullness for 2 years, along with nausea. The symptoms often occurred after consuming food that could cause gastric irritation, and the condition improved without intervention after 10 minutes. He had no history of gastrointestinal surgery. Gastroscopy revealed a protrusion lesion on the gastric fundus. A physical examination showed normal findings. Laboratory investigations noted a total bilirubin level of 34.9 μmol/L, direct bilirubin level of 14.6 μmol/L, and aspartate aminotransferase level of 178.6 U/L. Abdominal computed tomography revealed limited gastric fundus dilatation, cholecystolithiasis, and choledocholith. Endoscopic ultrasonography (EUS) showed a thickened gastric wall and an echo-poor submucosal layer of the gastric fundus.

Endoscopic retrograde cholangiopancreatography was performed after abdominal computed tomography revealed choledocholith. Intraoperative cholangiography detected multiple filling defects. Endoscopic papillary dilation was performed, and 2 firm stones were removed. The choledochus was assessed, and endoscopic nasobiliary drainage was used to perform intraoperative cholangiography to ensure no filling defect. There were no postoperative complications.

One week later, to define the characteristics of the gastric fundus lesion and reduce gastric surgery injury, endoscopic submucosal dissection (ESD) was performed. A 3 cm × 2 cm × 1.5 cm lesion was removed, and a 1.2 cm × 0.5 cm grey region, which had an eroded mucosal surface, was noted. An intraoperative cryo pathological examination revealed disordered gastric mucosal glands and single-gland dilatation in the muscularis mucosa and submucosa, without malignancy.

The histological examination revealed dilated cystic glands in the submucosa and bile deposit. These findings were consistent with a diagnosis of GCP without malignancy. A liquid diet was started on the morning after surgery, and the patient was discharged on the third day after surgery. There were no postoperative complications. Follow-up was performed at 3 months after surgical resection. Upper gastrointestinal barium meal revealed postoperative changes at the gastric fundus. Gastroscopy performed at 6 months after surgical resection showed superficial gastritis with bile reflux.

Source: Medicine: April 2019 - Volume 98 - Issue 17 - p e15295

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