The Black Esophagus - Biliary Plastic Stent, Part 1

Biliary Plastic Stent Our patient has the diagnosis of a cholangiocarcinoma Classic AEN presents as a circumferential, black-appearing, diffusely necrotic esophageal mucosa, preferentially affecting the distal esophagus, of variable length, that stops abruptly at the GEJ. Proximal extension of the mucosal injury is common and the entire esophagus can appear black. Differential diagnosis includes malignant melanoma, acanthosis nigricans, coal dust deposition, pseudomelanosis, and melanocytosis of the esophagus. Detailed history and physical examination provide essential clues to the diagnosis. Classic endoscopic appearance may be supported by brush cytology or biopsy specimen that will confirm the diagnosis. This is especially important in rare cases of isolated involvement of proximal and middle esophagus. Additionally, a history of corrosive ingestion should be sought for and diligently excluded.