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BACKGROUNDOesophageal cancer is the fourth most common cause of cancer-related deaths in India. Esophageal squamous cell carcinomas (ESCCs) arise from the epithelial layer, and commonly present as polypoidal, ulcerative or ulceroproliferative growth in the oesophageal lumen. In contrast, oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme (examples include leiomyoma, fibrovasculoma, lipoma, granular cell tumour or carcinoid), and mostly do not breach the mucosa. Oesophageal submucosal tumours are a distinct group of tumours arising from the mesenchyme, and mostly do not breach the mucosa. Complete intramural growth of an advanced primary ESCC is an exceedingly rare presentation, with only six cases reported in the literature thus far. We herein report a case of primary ESCC with complete intramural invasion that endoscopically mimics a submucosal lesion.CASE SUMMARYA 50 year old male presented with a progressive mechanical type of dysphagia for one month. His history was significant, including squamous cell carcinoma of the tongue that was treated with surgery and chemoradiation 1 year prior. Upper gastrointestinal endoscopy revealed a large, hemispherical lesion with normal-appearing overlying mucosa about 4 cm × 5 cm in size extending from 30-34 cm from incisors. The patient underwent endoscopic ultrasound (EUS), and a fine‑needle biopsy was performed, which was suggestive for squamous cell carcinoma. We herein report a case of primary ESCC with complete intramural invasion, endoscopically mimicking a submucosal lesion. The diagnosis could be established only by a EUS-guided biopsy.CONCLUSIONThis case report highlights that intramural ESCC may look like a submucosal lesion in endoscopy, and EUS biopsy is needed for final diagnosis.

Background: Peptic ulcer disease in patients with liver cirrhosis poses significant morbidity and mortality . It is also a cause for gastrointestinal bleed . Our study aims at providing a clinical and endoscopic profile of peptic ulcer disease in patients suffering from liver cirrhosis . Objective: Providing an insight into the clinical and endoscopic profile of patients suffering from liver cirrhosis and peptic ulcer disease, with special reference to Child Pugh score, spontaneous bacterial peritonitis, refractory ascites and other comorbidities. Methods: This study was conducted in the Department of Medical Gastroenterology, Govt Stanley medical college, Chennai from September 2018 to April 2019. All cirrhotic patients underwent relevant blood investigations, ultrasound abdomen, portal vein doppler and upper GI endoscopy. Gastric ulcers were biopsied according to standard protocol. RUT was not performed in all cases for H.Pylori detection . Results: A total of 361 cirrhotic patients that underwent upper GI endoscopy, 45 patients were incuded in our study based on the inclusion criteria. The prevalence of peptic ulcer disease in liver cirrhotics was 12.4% . Males to females ratio of 38:7. Mean age was 38 years ±2.8. Mean CTP score was 8.42±1.90 . median of 8 , mode 10 . Ascites was noted in 37, SBP in 22 and refractory ascites in 4. Etiology for cirrhosis was alcohol (44.4%) , cryptogenic(17.8%) , hepatitis B(15.6%) , Budd Chiari syndrome(8.9%) , hepatitis C(4.4%), wilsons disease (2.2%) , secondary biliary cirrhosis(2.2%) , autoimmune hepatitis(2.2%) . 23 had CPT score B, followed by CPT C in 15 and CPT A in 7 . Conclusion: In conclusion, a significant proportion of patients with cirrhosis develop PUD. Furthermore, H pylori infection and NSAIDs are not the only, or perhaps even the most important, risk factors for PUD in patients with cirrhosis. These observations have important practical implications for physicians caring for patients with chronic liver disease.