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.
Methods
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.
Results
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.
Conclusions
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.
Abbreviations:
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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Gastrointestinal EndoscopyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Schmidt FA. De mammalium oesophagus atque ventriculo [German]. Inaugural dissertation. Halle, Germany: Bethenea; 1805.
- Heterotopic gastric mucosa of the esophagus: literature-review and proposal of a clinicopathologic classification.Am J Gastroenterol. 2004; 99: 543-551
- 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
- Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch).Eur J Gastroenterol Hepatol. 2000; 12: 745-749
- Prevalence of endoscopically identified heterotopic gastric mucosa in the proximal esophagus: endoscopist dependent?.J Clin Gastroenterol. 2007; 41: 468-471
- Globus hystericus.Aust Fam Physician. 2013; 42: 683
- The globus symptom. Incidence, therapeutic response, and age and sex relationships.Arch Otolaryngol. 1982; 108: 740-744
- Heterotopic gastric mucosa in the cervical oesophagus (inlet patch) and globus pharyngeus—an under-recognised association.J Laryngol Otol. 2007; 121: 885-888
- Inlet patch of gastric mucosa in upper esophagus causing chronic cough and vocal cord dysfunction.Ann Allerg Asthma Immunol. 2006; 96: 112-115
- Acid secretion from an esophageal inlet patch demonstrated by ambulatory pH monitoring.Gastroenterology. 1998; 115: 1574-1576
- Symptomatic ectopic gastric epithelium of the cervical esophagus. Demonstration of acid production with Congo red.Dig Dis Sci. 1986; 31: 337-342
- Argon plasma ablation of gastric inlet patches in the cervical esophagus may alleviate globus sensation: a pilot trial.Endoscopy. 2006; 38: 566-570
- Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensations.Gastroenterology. 2009; 137: 440-444
- 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
- Mucosal ablation devices.Gastrointest Endosc. 2008; 68: 1031
- The efficacy and safety of argon plasma coagulation therapy in Barrett's esophagus.Gastrointest Endosc. 1999; 50: 18-22
Article info
Publication history
Published online: June 30, 2016
Accepted:
June 17,
2016
Received:
March 4,
2016
Footnotes
DISCLOSURE: The following author disclosed financial relationships relevant to this publication: J. M. Dunn: Educational grant recipient from Medtronic and Aquilant Endoscopy. All other authors disclosed no financial relationships relevant to this publication.
If you would like to chat with an author of this article, you may contact Dr Dunn at [email protected]
Identification
Copyright
Copyright © 2016 by the American Society for Gastrointestinal Endoscopy
