Development of white globe appearance lesions in the noncancerous stomach after vonoprazan administration: a report of t
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CASE REPORT
Development of white globe appearance lesions in the noncancerous stomach after vonoprazan administration: a report of two cases with a literature review Wataru Miwa1 · Takashi Hiratsuka1 · Ken Sato2 · Takashi Fujino3 · Yo Kato4 Received: 13 August 2020 / Accepted: 9 September 2020 © Japanese Society of Gastroenterology 2020
Abstract White globe appearance has recently been identified as a novel endoscopic marker useful in the diagnosis of early gastric cancer. Recently, this lesion has also been reported in the noncancerous stomach, including cases with autoimmune atrophic gastritis, although the clinical significance remains unclear. We present the details of a 68-year-old woman who began vonoprazan therapy for severe gastroesophageal reflux disease causing esophageal stricture. On follow-up endoscopy 1 year after beginning vonoprazan, multiple white globe appearance lesions developed in all sections of her stomach, except for the antrum. We also detected lesions during a yearly follow-up in the noncancerous stomach of a 70-year-old man who had received vonoprazan for 3 years. Lesions in both cases constituted cystic gland dilatations containing eosinophilic material. There was no evidence of accompanying autoimmune atrophic gastritis in either patient. This report is the first to our knowledge describing newly developed white globe appearance lesions in the noncancerous stomach during follow-up in two cases who received vonoprazan. Our findings suggest that these lesions in the noncancerous stomach might be associated with vonoprazan treatment. We investigated the two cases endoscopically and histologically, and we report our findings with a literature review. Keywords White globe appearance · Vonoprazan · Potassium-competitive acid blocker · Autoimmune atrophic gastritis
Introduction White globe appearance (WGA) was first reported in Japan by Doyama et al. in 2015 as a novel endoscopic marker useful in the diagnosis of early gastric cancer, especially when using magnifying endoscopy with narrow band imaging (NBI) [1]. Characterized by a small white globe-shaped lesion located underneath the epithelium with overlying * Wataru Miwa [email protected] 1
Division of Internal Medicine, Hiratsuka Gastroenterological Hospital, 3‑2‑16 Nishiikebukuro Toshima‑ku, Tokyo 171‑0021, Japan
2
Division of Surgery, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
3
Department of Cancer Genomic Medicine, Saitama Medical University International Medical Center, Saitama, Japan
4
Division of Pathology, Hiratsuka Gastroenterological Hospital, Tokyo, Japan
microvessels, WGA has been detected nearly exclusively in cancerous stomach lesions, even in a prospective study [2]. Therefore, detecting WGA is expected to contribute greatly to differentiating early gastric cancer from noncancerous lesions, which include low-grade adenoma. Yoshida et al. [2] also mentioned in the prospective study that WGA could very rarely be detected in benign lesions (three WGAs among 118 benign lesions). The authors specula
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