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• W2096133040 abstract "To the Editor: We read with interest the article by Park et al1Park C.H. Park J.M. Jung C.K. et al.Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection.Gastrointest Endosc. 2009; 69: e47-e50Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar regarding 2 patients with early gastric cancer accompanied by gastritis cystica polyposa (GCP) in the unoperated stomach. EUS revealed mucosal tumor with underlying multiple small cysts, and endoscopically resected specimens confirmed mucosal cancer with multiple submucosal cystic glands. Although GCP described by Park et al1Park C.H. Park J.M. Jung C.K. et al.Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection.Gastrointest Endosc. 2009; 69: e47-e50Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar occurred in the unoperated stomach, we believe that their GCP is a different entity from conventional GCP. Conventional GCP is characterized by elongated gastric foveolae and cystic dilated glands extending into the submucosa at the gastroenterostomy site.2Littler E.R. Gleibermann E. Gastritis cystic polyposa (gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia).Cancer. 1972; 29: 205-209Crossref PubMed Scopus (143) Google Scholar, 3Park J.S. Myung S.J. Jung H.Y. et al.Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach.Gastrointest Endosc. 2001; 54: 101-103Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 4Tuncer K. Alkanat M. Musoğlu A. et al.Gastritis cystica polyposa found in an unoperated stomach: an unusual case treated by endoscopic polypectomy.Endoscopy. 2003; 35: 882Crossref PubMed Scopus (6) Google Scholar, 5Okada M. Lizuka Y. Oh K. et al.Gastritis cystica profunda presenting as giant gastric mucosal folds: the role of endoscopic ultrasonography and mucosectomy in the diagnostic work-up.Gastrointest Endosc. 1994; 40: 640-644Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar The etiology and pathogenesis is considered to be postsurgical chronic inflammation caused by mucosal damage of bile reflux.3Park J.S. Myung S.J. Jung H.Y. et al.Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach.Gastrointest Endosc. 2001; 54: 101-103Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 5Okada M. Lizuka Y. Oh K. et al.Gastritis cystica profunda presenting as giant gastric mucosal folds: the role of endoscopic ultrasonography and mucosectomy in the diagnostic work-up.Gastrointest Endosc. 1994; 40: 640-644Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar In the operated stomach, surgical effects could allow migration of epithelial elements into the submucosa. Although GCP is considered a precancerous lesion,3Park J.S. Myung S.J. Jung H.Y. et al.Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach.Gastrointest Endosc. 2001; 54: 101-103Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 4Tuncer K. Alkanat M. Musoğlu A. et al.Gastritis cystica polyposa found in an unoperated stomach: an unusual case treated by endoscopic polypectomy.Endoscopy. 2003; 35: 882Crossref PubMed Scopus (6) Google Scholar we believe that gastroenterostomy itself carries an increased risk for gastric cancer occurrence mainly caused by mucosal damage of bile reflux.6Matsushita M. Hajiro K. Okazaki K. et al.Gastric cancer occurring at anastomosis after gastrojejunostomy without gastrectomy.Dig Dis Sci. 1998; 43: 898-900Crossref PubMed Scopus (3) Google Scholar We also reported gastric cancer at the gastroenterostomy site without GCP.6Matsushita M. Hajiro K. Okazaki K. et al.Gastric cancer occurring at anastomosis after gastrojejunostomy without gastrectomy.Dig Dis Sci. 1998; 43: 898-900Crossref PubMed Scopus (3) Google Scholar In 1963, before the first report of GCP in 1972,2Littler E.R. Gleibermann E. Gastritis cystic polyposa (gastric mucosal prolapse at gastroenterostomy site, with cystic and infiltrative epithelial hyperplasia).Cancer. 1972; 29: 205-209Crossref PubMed Scopus (143) Google Scholar a unique gastric disorder with the same histological features of GCP, heterotopic submucosal cysts (HSC), was described in the unoperated stomach.7Oberman H.A. Lodmell J.G. Sower N.D. Diffuse heterotopic cystic malformation of the stomach.N Engl J Med. 1963; 269: 909-911Crossref PubMed Scopus (65) Google Scholar We therefore believe that the GCP found in the unoperated stomach3Park J.S. Myung S.J. Jung H.Y. et al.Endoscopic treatment of gastritis cystica polyposa found in an unoperated stomach.Gastrointest Endosc. 2001; 54: 101-103Abstract Full Text Full Text PDF PubMed Scopus (24) Google Scholar, 4Tuncer K. Alkanat M. Musoğlu A. et al.Gastritis cystica polyposa found in an unoperated stomach: an unusual case treated by endoscopic polypectomy.Endoscopy. 2003; 35: 882Crossref PubMed Scopus (6) Google Scholar in 2 patients of Park et al1Park C.H. Park J.M. Jung C.K. et al.Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissection.Gastrointest Endosc. 2009; 69: e47-e50Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar was HSC. Although we8Kajiyama T. Kadowaki N. Tsuji K. et al.Clinical diagnosis of heterotopic submucosal gastric cysts by endoscopic ultrasonography (in Japanese with English abstract).Gastroenterol Endosc. 1989; 31: 2078-2088Google Scholar and other investigators9Martel W. Oberman H.A. Heterotopic submucosal gastric cysts: report of two cases, one in association with carcinoma.Gastrointest Radiol. 1978; 3: 391-395Crossref PubMed Scopus (7) Google Scholar reported that HSC was associated with gastric cancer, repeated erosion and regeneration induced by chronic inflammation cause carcinogenesis as well as gastric glands migration into the submucosa, and HSC is not carcinogenic.10Iwanaga T. Koyama H. Takahashi Y. et al.Diffuse submucosal cysts and carcinoma of the stomach.Cancer. 1975; 36: 606-614Crossref PubMed Scopus (70) Google Scholar When multiple cystic dilatations of gastric glands in the submucosa are revealed in the operated stomach at the gastroenterostomy site, we propose that the term gastritis cystica polyposa be used and that heterotopic submucosal cysts be used when the site is the unoperated stomach. Early gastric cancer associated with gastritis cystica polyposa in the unoperated stomach treated by endoscopic submucosal dissectionGastrointestinal EndoscopyVol. 69Issue 6PreviewGastritis cystica polyposa (GCP) is an uncommon hyperplastic benign lesion, which is histologically characterized by hyperplastic foveolar epithelia and multicystically dilated glands inside the lesion. GCP is also called gastritis cystica profunda when the cystic lesion locates within the submucosa. GCP was at first described as polypoid tumors developed in the gastric mucosa adjacent to Billroth-II stoma.1 This relatively rare lesion usually develops in patients who previously underwent gastroenterostomy, especially for treatment of a benign lesion, eg, gastric ulcer. Full-Text PDF ResponseGastrointestinal EndoscopyVol. 71Issue 6PreviewGastritis cystica polyposa (GCP) is defined as a hyperplastic polyp containing foci of misplaced foveolar or glandular epithelium (or both) in the muscularis mucosa or in the deeper portions of submucosa and muscularis mucosa.1,2 The term heterotopic submucosal cyst of the stomach, mentioned in the letter, seems to have been used in some reports from the late 1970s, written mostly by Japanese physicians.3-6 The condition was reported under several names, including multiple diffuse cystic disease, diffuse submucosal cystic disease, diffuse cystic glandular malformation, heterotopic gastric glands, and heterotopic submucosal gastric cysts. Full-Text PDF" @default.
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