Gastrointestinal Endoscopy
Volume 71, Issue 3 , Page 658, March 2010

Isolated proximal black esophagus: etiology and the role of tissue biopsy

Department of Gastroenterology, St. Vincent's Medical Center/New York Medical College, New York, New York, USA

Article Outline

 

To the Editor:

We read with interest the article by Neumann et al1 on proximal black esophagus, in which they describe proximal acute necrotizing esophagitis in a patient who underwent cardiac catheterization for acute myocardial infarction. Their case is consistent with our recently published analysis.2 Black esophagus is thought to occur from a combination of hemodynamic compromise, transient gastric outlet obstruction with backflow injury, and altered mucosal barrier systems. Predilection to the distal esophagus is almost universal (97.5%), and only 2 reported cases describe isolated involvement of the middle third of the organ.2 Vascular supply to the cervical esophagus is derived from the descending branches of the inferior thyroid arteries, with additional variable blood supply from other branches.3 The mechanism of isolated injury to the cervical esophagus may be related to a selective embolic event or mechanical trauma from accidental cannulation of a thyrocervical trunk, compromising blood supply, both possible complications of a cardiac catheterization.

It would be helpful to review catheterization films and find out whether a femoral artery or a radial artery approach was used. Isolated proximal esophageal injury without evidence of distal necrosis may also result from a mechanical or chemical trauma to the esophagus. Was an attempt at endotracheal or nasogastric intubation made in this patient prior to diagnosis?

Tissue sampling is supportive but is not required to establish the diagnosis in classic black esophagus that ends on the Z line. However, we would have initially obtained a biopsy specimen or brush cytology of the isolated proximal area to exclude infectious causes and rule out malingnant melanoma, acanthosis nigricans, pseudomelanosis, and melanosis of the esophagus.2

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References 

  1. Neumann DA, Francis DL, Baron TH. Proximal black esophagus: a case report and review of the literature. Gastrointest Endosc. 2009;70:180–181
  2. Gurvits GE, Shapsis A, Lau N, et al. Acute esophageal necrosis: a rare syndrome. J Gastroenterol. 2007;42:29–38
  3. Park JH, Kim HC, Chung JW, et al. Transcatheter arterial embolization of arterial esophageal bleeding with the use of N-butyl cyanoacrylate. Korean J Radiol. 2009;10:361–365

PII: S0016-5107(09)02263-9

doi:10.1016/j.gie.2009.07.021

Gastrointestinal Endoscopy
Volume 71, Issue 3 , Page 658, March 2010

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