Unique Endoscopic Presentation of “Reversed Reflux”-type Cameron Lesions

CLINICAL REPORT

A 49-year-old female patient presented for outpatient esophagogastroduodenoscopy (EGD) for dyspeptic complaints. While in the lower esophagus the Z line emerged at 34 cm from the incisors without signs of erosive reflux lesions, several reddish linear lesions developed downward into a small type 1 hiatal hernia with the diaphragmatic indentation at 36 cm (Fig. 1A). The latter finding of Cameron lesions was further highlighted by the implementation of image-enhanced endoscopy using linked color imaging (LCI) technology (Eluxeo, Fujifilm), also illustrating minor extension into the stomach along the minor curvature and a trajectorial course along gastric body folds (Fig. 1B). By contrast, the distinct proximal demarcation line of these lesions up to, but not extending the squamocolumnar junction, potentially reflective of differential susceptibility to mechanical and/or chemical irritation relative to histopathological build-up, was clearly demonstrated by prograde (Fig. 1C) and retrograde (Fig. 1D) endoscopic visualization by gentle retroflexion. The patient was successfully treated with proton-pump inhibition as per clinical and endoscopic reassessment.

While Cameron lesions are common, though likewise commonly unappreciated, complications in patients with hiatal hernias, the distinct finding of what might be designated as “reverse reflux”-type mirroring typical erosive reflux lesions at the Z line represents a unique and as yet unreported endoscopic presentation.¹

REFERENCE

1. Maganty K, Smith RL. Cameron lesions: unusual cause of gastrointestinal bleeding and anemia. Digestion 2008;77(3–4):214–217. DOI: 10.1159/000144281.