Cervical inlet patch: new insights into diagnosis and endoscopic therapy

Abstract

The cervical inlet patch is an island of heterotopic gastric mucosa, most commonly found in the proximal oesophagus. Its importance as a cause of throat symptoms has been recognised, particularly chronic globus sensation. This has led to a change in the Rome IV criteria for globus management, with emphasis on ruling out the condition. Proton pump inhibitors are often ineffective in resolving symptoms. Endoscopic studies on the use of ablative techniques, most recently radiofrequency ablation (RFA), have shown promise in reversing the CIP to mormal squamous mucosa, with subsequent symtpomatic resolution. The aim of this review is to update on the investigation and management of the CIP.

Keywords: acid-related diseases; oesophageal disorders.

Figure 1

Histological types of inlet patch: oxyntic mucosa (left) and cardiac mucosa (right) (Images courtesy of Dr Fuju Chang).

Figure 2

(A) Salmon coloured patch of mucosa found in the proximal oesophagus, just distal to the upper oesophageal sphincter. (B) On occasion, more than one inlet patch may be present.

Figure 3

(A) Small inlet patch in the cervical part of the oesophagus, left wall narrow band imaging (NBI) and (B) circumferential inlet patch (NBI).

Figure 4

Cervical inlet patch before and after ablation with RFA from clockwise, (A) inlet patch at 10 o’clock position, (B) immediately after first RFA (TTS), (C) at 3 months after first ablation there is squamous regeneration but a tiny central foci remains. (D) complete squamous regeneration at 3 months postsecond RFA. RFA, radiofrequency ablation.