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Case Reports
. 2025 May 5;12(5):e01698.
doi: 10.14309/crj.0000000000001698. eCollection 2025 May.

Esophageal Epidermoid Metaplasia Treated With Endoscopic Submucosal Dissection

Karam Al-Bayati  1 , Gerard Coneys  2 , Michael Cantor  1 , Rodica Gheorghe  3 , James K Stone  2
Affiliations
Case Reports

Esophageal Epidermoid Metaplasia Treated With Endoscopic Submucosal Dissection

Karam Al-Bayati et al. ACG Case Rep J. .

Abstract

Esophageal epidermoid metaplasia (EEM) is a rare condition characterized by well-demarcated leukoplakia affecting the middle-to-distal esophagus. EEM commonly presents in middle-aged females with dysphagia and gastroesophageal reflux. EEM is thought to be associated with high-grade squamous dysplasia and squamous cell carcinoma. We report a case of a 63-year-old woman diagnosed with EEM after en bloc endoscopic submucosal dissection in a lesion initially reported as squamous dysplasia. The patient was initiated on a PPI with a 6-month follow-up showing no areas of squamous dysplasia or recurrent EEM with normal squamous mucosa on biopsy. The patient was symptom-free at 1-year follow-up.

Keywords: endoscopic submucosal dissection; esophageal epidermoid metaplasia; high-grade squamous dysplasia; squamous cell carcinoma.

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Figures

Figure 1.
Figure 1.
Appearance of EEM under light endoscopy with white, scaly, and nodular lesions to mid-esophagus (A), under Narrow Band Imaging (B), and under 1% Lugol iodine stain (C). Marking the borders of the lesion using the soft coagulation setting on the ESD ProKnife (Boston Scientific, Marlborough, MA) (D). Endoscopic appearance of EEM after en bloc resection (E). Resection biopsy at low magnification showing undulating squamous mucosa (black arrow) (F) and at 20× magnification showing a prominent granular layer of 1–4 cells thick with an overlying hyperorthokeratosis (black arrows) (G). Endoscopic appearance of EEM scar at 6-month follow-up under Narrow Band Imaging (H), and at 12-month follow up under 1% Lugol iodine stain (I). EEM, esophageal epidermoid metaplasia; ESD, endoscopic submucosal dissection.
See this image and copyright information in PMC

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