Sentinel polyp and fold
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CLASSICS IN ABDOMINAL RADIOLOGY
Sentinel polyp and fold Robert D’Agostino1 · Naiim Ali1 Received: 30 June 2020 / Revised: 10 August 2020 / Accepted: 21 August 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
In his discussion of endoscopic findings in esophagitis, Boyce described the sentinel polyp and fold consisting of a round firm lesion at or just below the gastroesophageal junction associated with a prominent fold leading up to it from the gastric fundus [1, 2]. This finding was subsequently described on fluoroscopy in 1978 as a stage in the development of chronic esophagitis [3]. Just as a sentinel is defined as a “soldier or guard who job is to stand and keep watch” (Fig. 1) and medically as “an indicator of the presence of disease” [4], the sentinel polyp and fold serve as indicators of hyperplastic polyps most commonly caused by gastroesophageal reflux resulting in esophagitis [5]. During a barium esophagram, the demonstration of a prominent, straight gastric fold terminating in a smooth polypoid expansion near the squamocolumnar junction suggests a sentinel polyp and fold (Fig. 2). In a patient with gastroesophageal reflux, this sentinel polyp and fold is characteristic of a benign inflammatory gastroesophageal
polyp, making endoscopy or biopsy unnecessary [6]. The differential diagnosis of filling defects at the esophageal squamocolumnar junction includes varices, adenomatous polyps, foreign bodies, leiomyomas, and malignancy [6]. Therefore, any variability in the classic appearance should mandate further endoscopic evaluation.
Funding No funding was received for this study.
Compliance with ethical standards Conflict of interest The authors declare that they have no conflict of interest. Ethical approval The article does not contain any studies with human participants or animals performed by any of the authors. Informed consent Statement of informed consent was not applicable since the manuscript does not contain any patient data.
* Naiim Ali [email protected] Robert D’Agostino [email protected] 1
University of Vermont Medical Center, Burlington, USA
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Abdominal Radiology
Fig. 1 A Swiss Guard watches over an entrance in Vatican City. (https://pixaba y.com/photos /swiss-guard- vatica n-vatica n-guard-11288 57/) Accessed June 30, 2020
Fig. 2 Fluoroscopic esophagram performed with barium and effervescent crystals in a 28-year-old male with a history of gastroesophageal reflux. Double-contrast upright left posterior oblique (a) and single-contrast prone right anterior oblique (b) radiographs
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show thickened gastric fold (arrows) leading to and associated with a smoothly rounded filling defect (arrowhead) at the gastroesophageal junction with a small sliding hiatal hernia
Abdominal Radiology
References 1. Boyce HW. Esophagoscopy. Presented at the 3rd Annual Postgraduate Course on Gastrointestinal Endoscopy, Dallas, Texas, May 22–23, 1972. 2. Eisenberg, RL Gastrointestinal Radiology: A Pattern Approach. 4
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