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World J Gastroenterol. Apr 7, 2020; 26(13): 1439-1449
Published online Apr 7, 2020. doi: 10.3748/wjg.v26.i13.1439
Review of the diagnosis of gastrointestinal lanthanum deposition
Masaya Iwamuro, Haruo Urata, Takehiro Tanaka, Hiroyuki Okada
Masaya Iwamuro, Hiroyuki Okada, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama 7008558, Japan
Haruo Urata, Central Research Laboratory, Okayama University Medical School, Okayama 7008558, Japan
Takehiro Tanaka, Department of Pathology, Okayama University Hospital, Okayama 7008558, Japan
Author contributions: Iwamuro M designed the research study and wrote the paper; Urata H and Tanaka T critically reviewed the manuscript for important intellectual content; Okada H approved the manuscript.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Masaya Iwamuro, MD, PhD, Assistant Professor, Doctor, Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-Ku, Okayama 7008558, Japan. iwamuromasaya@yahoo.co.jp
Received: December 21, 2019
Peer-review started: December 21, 2019
First decision: January 3, 2020
Revised: January 20, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: April 7, 2020
Processing time: 108 Days and 14.2 Hours
Abstract

Lanthanum carbonate is used for treatment of hyperphosphatemia mostly in patients with chronic renal failure. Although lanthanum carbonate is safe, recently, lanthanum deposition in the gastrointestinal mucosa of patients has been reported in the literature. This review provides an overview of gastroduodenal lanthanum deposition and focuses on disease’s endoscopic, radiological, and histological features, prevalence, and outcome, by reviewing relevant clinical studies, case reports, and basic research findings, to better understand the endoscopic manifestation of gastrointestinal lanthanum deposition. The possible relationship between gastric lanthanum deposition pattern and gastric mucosal atrophy is also illustrated; in patients without gastric mucosal atrophy, gastric lanthanum deposition appears as diffuse white lesions in the posterior wall and lesser curvature of the gastric body. In the gastric mucosa with atrophy, lanthanum-related lesions likely appear as annular or granular whitish lesions. Moreover, these white lesions are probably more frequently observed in the lower part of the stomach, where intestinal metaplasia begins.

Keywords: Lanthanum carbonate; Hyperphosphatemia; Gastrointestinal endoscopy; Lanthanum phosphate; Scanning electron microscopy; Energy-dispersive X-ray spectrometry

Core tip: This review provides an overview of the endoscopic and pathological diagnosis of gastroduodenal lanthanum deposition. Previously reported case reports, case series, and retrospective studies are reviewed, focusing on disease’s endoscopic, histological, and computed tomography features, prevalence, and outcome. Although gastroduodenal deposition presents with white appearance at esophagogastroduodenoscopy, macroscopic features and locations of gastric lesions possibly vary depending on the presence or absence of mucosal atrophy. Our hypotheses are also related to the pattern of lanthanum deposition in the gastric mucosa with/without atrophy, which will aid endoscopists to understand this disease entity.