Introduction
The cervical inlet patch (CIP) is an islet of heterotopic gastric mucosa that is observed in the upper esophagus during conventional diagnostic esophagogastroduodenoscopy. Commonly encountered laryngopharyngeal symptoms, including globus sensation, hoarseness, odynophagia, and dysphagia, have been linked to CIP. In most cases, medical intervention for symptomatic CIP commences with the administration of potent acid suppressive agents, such as proton-pump inhibitors (PPI); however, the efficacy of these agents is limited. A few Western studies have demonstrated that endoscopic therapy with argon plasma coagulation (APC) is increasingly effective in relieving laryngopharyngeal symptoms in patients with CIP.1,2 Additionally, long-term effects lasting up to 27 months of follow-up have been documented.3 Regarding the use of APC in patients with CIP, however, no pertinent research has been conducted in Asia-Pacific countries. Therefore, we retrospectively reviewed a cohort with six symptomatic CIP patients recruited for the APC ablation therapy. This case shed light on the possible use of APC for symptomatic CIP patients in Asia-Pacific countries.
Aims & Methods
We recruited a total of six symptomatic patients, proven to be CIP endoscopically and pathologically, from May 22, 2022, to April 20, 2024. We excluded patients who were less than 20 years old and who refused the option of argon plasma coagulation ablation. To ablate the CIP, all recruited patients underwent endoscopic ablation at 60 W and 2 L/min in one session. Questionnaires consisting of visual analog scores (from 0 to 10. The higher the score, the more severe the symptoms) for symptoms of dry throat, burning throat, globus sensation, hoarseness and clearing throat were distributed to patients at the time points of before the use of proton pump inhibitors, after the use of proton pump inhibitors and one month after the endoscopic ablation with APC to assess the efficacy endoscopic procedure. We defined symptomatic CIP with at least one any of the aforementioned symptoms with more than 5 out of 10 of pain score.
Results
The current study recruited a total of six patients. Two-thirds of patients were female (4/6) in gender and had an average age of 41 years. The CIP was located in the upper esophagus at 16.7cm from the incisors (15–18 cm), and two-thirds of the patients had more than one CIP. The average size of CIP was about 0.6 cm (ranging from 0.3cm to 0.8cm). The APC ablation significantly improved the five parameters (dry throat, burning sensation, foreign body sensation, and hoarseness) from more than 4/10 to less than 2/10. Foreign body sensation showed the most prominent improvement, decreasing from 7/10 to 1/10. (Figure1) There were no complications, such as perforation, infection, ulcers, or stricture, after the procedure. One month after the APC procedure, the follow-up EGD of all patients showed no residual CIP.
Conclusion
APC ablation shows a promising results for symptomatic CIP patients with laryngopharyngeal symptoms in Asia-Pacific population. However, further prospective randomized studies with a larger sample size are needed to validate the effectiveness and safety of APC ablation in symptomatic CIP patients in the region.
References
1. 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 Aug;137(2):440-4.
2. Brechmann T, Muhlenkamp M, Schmiegel W, et al. Argon Plasma Coagulation of Gastric Inlet Patches of the Cervical Esophagus Relieves Vocal and Respiratory Symptoms in Selected Patients. Dig Dis Sci 2023; 68: 1936-1943.
3. 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(3):165-71.
Disclosure
There is no conflict of interest among authors