{"id":3731,"date":"2015-06-10T10:30:15","date_gmt":"2015-06-10T10:30:15","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/caso-clinico-estenose-benigna-esofagiana\/"},"modified":"2022-06-17T15:43:15","modified_gmt":"2022-06-17T15:43:15","slug":"caso-clinico-estenose-benigna-esofagiana","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-estenose-benigna-esofagiana\/","title":{"rendered":"Estenose benigna de es\u00f4fago"},"content":{"rendered":"

Paciente do sexo masculino, 32 anos, evoluindo com quadro de disfagia para s\u00f3lidos e engasgos h\u00e1 cerca de 4 meses. Negava odinofagia, dor tor\u00e1cica ou perda peso. N\u00e3o apresentava comorbidades ou hist\u00f3ria de ingesta de ca\u00fasticos. Ao exame f\u00edsico apresentava-se em bom estado geral, eutr\u00f3fico, com mucosas normocr\u00f4micas e sem achados suspeitos ao exame segmentar. Submetido a endoscopia digestiva alta que evidenciou a 20 cm da arcada dent\u00e1ria superior a imagem apresentada abaixo.<\/p>\n

 <\/p>\n

\"Estenose2\"<\/a><\/p>\n

Figura 1. Estenose anelar em es\u00f4fago proximal com presen\u00e7a de mucosa r\u00f3seo salm\u00e3o circunjacente.<\/p>\n

Foi evidenciado, portanto, a presen\u00e7a de uma estenose anelar em es\u00f4fago proximal que impedia a passagem do aparelho, associado a presen\u00e7a de mucosa adjacente suspeita de mucosa g\u00e1strica ect\u00f3pica. Procedida a dilata\u00e7\u00e3o da estenose com sondas de Savary.<\/p>\n

\"Estenose1\"<\/a><\/p>\n

Figura 2. Aspecto da estenose ap\u00f3s dilata\u00e7\u00e3o com sondas de Savary com evid\u00eancia de lacera\u00e7\u00f5es superficiais.<\/p>\n

Ap\u00f3s a dilata\u00e7\u00e3o foi poss\u00edvel a progress\u00e3o do aparelho atrav\u00e9s da estenose, n\u00e3o sendo evidenciados outros achados patol\u00f3gicos ao exame. Realizadas bi\u00f3psias tanto da \u00e1rea de estenose quanto da mucosa adjacente.<\/p>\n

Ap\u00f3s a dilata\u00e7\u00e3o o paciente evoluiu com melhora clinica importante, com boa aceita\u00e7\u00e3o de alimentos s\u00f3lidos. As bi\u00f3psias realizadas confirmaram a suspeita de mucosa g\u00e1strica ect\u00f3pica e estenose ben\u00edgna associada.<\/p>\n

Discuss\u00e3o:<\/p>\n

A presen\u00e7a de mucosa g\u00e1strica ect\u00f3pica ocorre em todo o trato gastrointestinal por supostos remanescentes embriol\u00f3gicos, sendo uma das formas mais comuns a de es\u00f4fago, no qual possui preval\u00eancia estimada de at\u00e9 20% da popula\u00e7\u00e3o.<\/p>\n

A maioria das ectopias de mucosa g\u00e1strica em es\u00f4fago s\u00e3o encontrados incidentalmente e geralmente s\u00e3o assintom\u00e1ticas. No entanto, a produ\u00e7\u00e3o de \u00e1cido pela mucosa ect\u00f3pica j\u00e1 foi demonstrada podendo resultar em \u00falceras, hemorragia, estenoses e perfura\u00e7\u00e3o. Outras complica\u00e7\u00f5es relatadas incluem f\u00edstula traqueoesof\u00e1gica, coloniza\u00e7\u00e3o por Helicobacter pylori e mesmo adenocarcinoma origin\u00e1rio desse epit\u00e9lio.<\/p>\n

O tratamento das estenoses associadas \u00e0 mucosa g\u00e1strica ect\u00f3pica envolvem tanto a dilata\u00e7\u00e3o com sondas ou bal\u00f5es, quanto o bloqueio \u00e1cido com uso de inibidor de bomba de pr\u00f3ton preferencialmente. A abla\u00e7\u00e3o da mucosa com plasma de arg\u00f4nio tamb\u00e9m \u00e9 descrita como estrat\u00e9gia terap\u00eautica.<\/p>\n

Literatura sugerida:<\/p>\n

    \n
  1. Ward EM, Achem SR. Gastric heterotopia in the proximal esophagus complicated by stricture. Gastrointest Endosc.<\/em> 2003 Jan;57(1):131-3.<\/li>\n
  2. Waring, JP and Wo, JM. Cervical esophageal web caused by an inlet patch of gastric mucosa. South Med J<\/em>.1997; 90: 554\u2013555<\/li>\n
  3. Jerome-Zapadka, KM, Clarke, MR, and Sekas, G. Recurrent upper esophageal webs in association with heterotopic gastric mucosa: case report and literature review. Am J Gastroenterol<\/em>. 1994; 89: 421\u2013424<\/li>\n
  4. Jabbari, M, Goresky, CA, Lough, J, Yaffe, C, Daly, D, and Cote, C. The inlet patch: heterotopic gastric mucosa in the upper esophagus. Gastroenterology<\/em>. 1985; 89: 352\u2013356<\/li>\n
  5. Galan, AR, Katzka, DA, and Castell, DO. Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring. Gastroenterology<\/em>. 1998; 115: 1574\u20131576<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Paciente do sexo masculino, 32 anos, evoluindo com quadro de disfagia para s\u00f3lidos e…<\/p>\n","protected":false},"author":726,"featured_media":3732,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[282],"tipo":[153],"volume":[263],"class_list":["post-3731","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-282","tipo-endoscopia-digestiva-alta","volume-volume-i"],"yoast_head":"\nEstenose benigna de es\u00f4fago • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-estenose-benigna-esofagiana\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Estenose benigna de es\u00f4fago\" \/>\n<meta property=\"og:description\" content=\"Paciente do sexo masculino, 32 anos, evoluindo com quadro de disfagia para s\u00f3lidos e engasgos h\u00e1 cerca de 4 meses. 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