Diagnosis and management of a rare case of esophageal epidermoid metaplasia: A case report.

BACKGROUND: Esophageal epidermoid metaplasia (EEM) is a rare potentially premalignant oesophageal lesion characterized by a dense granular layer with overlying hyperorthokeratosis resembling the epidermis of skin. Given the low prevalence, data to guide management also remains sparse. CASE SUMMARY: We highlight a case of a 60-year-old male who presented with gastroesophageal reflux disease symptoms 2 years after an index gastroscopy which showed C0M1 Barrett's oesophagus. The repeat gastroscopy detected a 15 mm oesophageal epidermoid metaplasia on a background of stable Barrett's esophagus. This was rather peculiar as the images form his index gastroscopy 2 years prior did not reveal any suspicious oesophageal mucosal abnormality. He underwent a successful endoscopic mucosal resection within 3 months with a surveillance gastroscopy scheduled 6 months later. The cases of confirmed EEM are very low. One study demonstrated out of 1048 consecutive oesophageal biopsies and resections for any indication, only two were EEM (0.19%). It was also noted that the prevalence of epidermoid metaplasia was significantly higher (P < 0.05) in the 58 patients with oesophageal squamous neoplasms, two of whom (3.5%) had concurrent epidermoid metaplasia. CONCLUSION: This association necessitates careful consideration when determining resection vs surveillance-based management of EEM.