New methods Clinical endoscopy| Volume 84, ISSUE 6, P1022-1026.e2, December 2016

Radiofrequency ablation of symptomatic cervical inlet patch using a through-the-scope device: a pilot study

      Background and Aims

      The cervical inlet patch (CIP) is an area of heterotopic gastric mucosa at the proximal esophagus, which can secrete both acid and mucus. Attributable symptoms include chronic globus sensation and sore throat. Previous studies have demonstrated improvement in symptoms after ablation using argon plasma coagulation. Our aim was to assess a through-the-scope radiofrequency ablation (RFA) catheter for ablation of symptomatic CIP.


      Ten patients with endoscopically and histologically proven CIP and symptoms of globus or sore throat were included in the study. An ablation protocol of 3 ablations at 12 J/cm2, without removal of coagulated tissue between ablations, was used. A maximum of 2 RFA sessions, 3 months apart, was allowed. A visual analog score was completed at baseline, 6 weeks (on proton pump inhibitor), 3 months (off proton pump inhibitor), and 12 months after treatment.


      Mean patient age was 56 years (±3 years, standard error of the mean), 60% were men, and 80% were white. Barrett’s esophagus was present in 50%. The mean number of CIPs was 2 (range, 1-4) with a median surface area of 2 cm2 (range, .5-14). After a median of 2 treatments, 80% achieved complete endoscopic and histologic resolution, with a mean follow-up of 14 months (range, 12-17). Globus, sore throat, and cough significantly improved from baseline (P < .05). No strictures or buried glands were identified.


      This prospective pilot study demonstrates that RFA using a through-the-scope device is safe and effective for treating patients with symptomatic CIP. One-year follow-up data suggest the effect is durable.


      APC (argon plasma coagulation), CIP (cervical inlet patch), CR-CIP (complete reversal of cervical inlet patch), PPI (proton pump inhibitor), RFA (radiofrequency ablation), VAS (visual analog scale)
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      1. Schmidt FA. De mammalium oesophagus atque ventriculo [German]. Inaugural dissertation. Halle, Germany: Bethenea; 1805.

        • von Rahden B.H.
        • Stein H.J.
        • Becker K.
        • et al.
        Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification.
        Am J Gastroenterol. 2004; 99: 543-551
        • Ohara M.
        Incidence of heterotopic gastric mucosa in the upper esophagus in first time narrow banding image endoscopy of consecutive 900 patients [abstract].
        Gastrointest Endosc. 2010; 71: AB316-AB317
        • Maconi G.
        • Pace F.
        • Vago L.
        • et al.
        Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch).
        Eur J Gastroenterol Hepatol. 2000; 12: 745-749
        • Azar C.
        • Jamali F.
        • Tamim H.
        • et al.
        Prevalence of endoscopically identified heterotopic gastric mucosa in the proximal esophagus: endoscopist dependent?.
        J Clin Gastroenterol. 2007; 41: 468-471
        • Pollack A.
        • Charles J.
        • Harrison C.
        • et al.
        Globus hystericus.
        Aust Fam Physician. 2013; 42: 683
        • Moloy P.J.
        • Charter R.
        The globus symptom. Incidence, therapeutic response, and age and sex relationships.
        Arch Otolaryngol. 1982; 108: 740-744
        • Alaani A.
        • Jassar P.
        • Warfield A.T.
        • et al.
        Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus—an under-recognised association.
        J Laryngol Otol. 2007; 121: 885-888
        • Silvers W.S.
        • Levine J.S.
        • Poole J.A.
        • et al.
        Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.
        Ann Allerg Asthma Immunol. 2006; 96: 112-115
        • Galan A.R.
        • Katzka D.A.
        • Castell D.O.
        Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring.
        Gastroenterology. 1998; 115: 1574-1576
        • Hamilton J.W.
        • Thune R.G.
        • Morrissey J.F.
        Symptomatic ectopic gastric epithelium of the cervical esophagus. Demonstration of acid production with Congo red.
        Dig Dis Sci. 1986; 31: 337-342
        • Meining A.
        • Bajbouj M.
        • Preeg M.
        • et al.
        Argon plasma ablation of gastric inlet patches in the cervical esophagus may alleviate globus sensation: a pilot trial.
        Endoscopy. 2006; 38: 566-570
        • Bajbouj M.
        • Becker V.
        • Eckel F.
        • et al.
        Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations.
        Gastroenterology. 2009; 137: 440-444
        • Klare P.
        • Meining A.
        • von Delius S.
        • et al.
        Argon plasma coagulation of gastric inlet patches for the treatment of globus sensation: it is an effective therapy in the long term.
        Digestion. 2013; 88: 165-171
        • ASGE Technology Committee Technical Review
        Mucosal ablation devices.
        Gastrointest Endosc. 2008; 68: 1031
        • Grade A.J.
        • Shah I.A.
        • Medlin S.M.
        • et al.
        The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus.
        Gastrointest Endosc. 1999; 50: 18-22