A 62-year-old woman was referred for investigation of heartburn. She did not have any other significant medical history and denied any other symptoms including weight loss, dysphagia, odynophagia, regurgitation and hematemesis. Her only medication was pantoprazole 40 mg daily for her gastroesophageal reflux disease. Endoscopy was performed with a GIF-Q180 gastroscope (Olympus Optical, Japan), which demonstrated multiple flesh-coloured pedunculated papules at the gastroesophageal junction (Figure 1). Biopsies demonstrating atypical epithelial proliferation confirmed the diagnosis of esophageal squamous papillomatosis, without the presence of dysplasia or carcinoma. A polymerase chain reaction study was negative for herpes simplex virus. Following discussion with the patient, an extensive endoscopic mucosal resection (EMR) incorporating all of the lesions was performed using a band mucosectomy device (Duette, Cook Medical, Ireland) (Figures 2 and 3). Histology from the EMR specimens was similar to the original mucosal biopsy results. No immediate or delayed complications occurred.
Hepatitis C (HCV) infection is prevalent in recipients of, and candidates for, solid organ transplants. The outcomes of HCV infection in cardiac and lung transplant recipients have yet to be clearly established, and future prospective studies are needed. In the absence of safe and effective antiviral treatment for HCV infection in heart and lung transplant recipients, the management of these patients remains a challenge and must be considered on an individual basis. Interferon therapy for HCV before transplantation appears to improve outcomes; however, post-transplant interferon therapy in the cardiac and pulmonary transplant setting may be associated with an increased risk of graft rejection. Given the paucity of information regarding HCV treatment in these transplant recipients, and with appropriate concerns that graft loss from rejection may not be amenable to a second transplant (given the scarcity of suitable cadaveric organs), multicentre, randomized controlled trials are needed to determine the optimal approach for treatment of HCV infection in this population.
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