A Polyp at the GOJ

This patient was referred for an OGD after complaining of dyspepsia improving with PPI. This nodule is noted at the GOJ
WHAT IS THE MOST LIKELY DIAGNOSIS?

■ Hyperplastic/Inflammatory polyp

A shrewd guess!

■ Adenomatous polyp

Never seen one at the GOJ!

■ Dysplastic polyp

That villous surface is reassuring and makes it more likely to be inflammatory!

■ Superficial SCC

SCC's never have a villous surface like this!

■ Superficial adenocarcinoma

Villous surface and nearby reflux ulcer makes it unlikely

explanation

At first, that 'villous' surface may look disconcerting. However, you should know that in the oesophagus and stomach, polyps arising due to inflammation and oedema, (so called 'reactive or 'inflammatory' or 'hyperplastic' polyps) usually have a villous or gyrate surface pattern. In the stomach, these polyps often have an angrily red appearance and some white blobs making them look a little like pretty mushrooms (see example below).  

OK, if this polyp is 'inflammatory', why is there inflammation?  You can see a linear reflux ulcer in the 3 O'clock position. THIS is the reason for the inflammatory polyp. Of course, you'll take a couple of biopsies but as always, make an Endoscopic Diagnosis!  You ARE a Professional and NOT a simple technitian unthinkingly feeding biopsies to the guys with brains!