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Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases

Year 2020, Volume: 4 Issue: 12, 1219 - 1222, 01.12.2020
https://doi.org/10.28982/josam.820639

Abstract

Aim: The inlet patch, also called as the heterotopic gastric mucosa, is often located in proximal esophagus and is generally asymptomatic. These lesions are rarely polypoid and mostly have a patchy pattern. In the literature, there are only few cases of inlet patches that show a malignant progression following a metaplasia- dysplasia- adenocarcinoma sequence. In our study, we aimed to present the endoscopic and morphological features of our case series.
Methods: The study, which was conducted in two clinics, included the inlet patch cases diagnosed in esophagus biopsy materials between 2016 and 2019. The slides and the demographic data of the cases were re-analyzed.
Results: Among 4190 cases whose esophageal biopsies were examined, 63 inlet patches (1.5%) were diagnosed. Thirty four cases were male and 29 were female. Age range was 16-82 years. The cases were mostly located in proximal esophagus and the size of the lesions ranged between 0.2-3.5 cm. One of the four cases with polypoid appearance was microscopically diagnosed as a hyperplastic polyp. The most common gastric type epithelium was the oxyntic type. Helicobacter pylori was observed in four cases, and intestinal metaplasia and low-grade dysplasia were observed in one. No malignancy was diagnosed in our series.
Conclusion: Although benign, the inlet patch is significant due to its risk of progression to malignancy. Thus, obtaining biopsies from each lesion endoscopically considered as inlet patch is recommended. This will help determine the precise incidence of the inlet patch and more importantly, identify neoplasia earlier.

References

  • 1. Terada T. Heterotopic gastric mucosa of the gastrointestinal tract: A histopathologic study of 158 cases. Pathol Res Pract. 2011;207(3):148-50. doi: 10.1016/j.prp.2010.12.004.
  • 2. Orizio P, Villanacci V, Bassotti G, Falchetti D, Torri F, Ekema G. Heterotopic gastric mucosa in the cystic duct. Int J Surg Pathol. 2011;19(3):364-5. doi: 10.1177/1066896909337717.
  • 3. Peitz U, Vieth M, Evert M, Arand J, Roessner A, Malfertheiner P. The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett's esophagus. BMC Gastroenterol. 2017;17(1):87. doi: 10.1186/s12876-017-0644-3.
  • 4. Lupu VV, Ignat A, Paduraru G, Mihaila D, Burlea M, Ciubara A. Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report. Medicine . 2015;94(42):e1722. doi: 10.1097/MD.0000000000001722.
  • 5. Mete R, Oran M, Yüksek A, Gürdal SÖ, Coşkunkan U, Aydın U, et al. Yutma güçlüğü ile başvuran inlet patch olgusu. Int J Basic Clin Med. 2013;1(2):120-2. http://hdl.handle.net/20.500.11776/2223.
  • 6. Alagozlu H, Ergun M, Cindoruk M, Unal S, Dumlu S, Poyraz A, et al. The rare presentations of a large polyp and an esophageal carcinoma in heterotopic gastric mucosa: a case series. J Med Case Rep. 2007;127:1-4. doi: 10.1186/1752-1947-1-127.
  • 7. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol. 2013;19(3):331-8. doi: 10.3748/wjg.v19.i3.331.
  • 8. Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol. 2018;9(3):214-20. doi: 10.1136/flgastro-2017-100855.
  • 9. Riddiough GE, Hornby ST, Asadi K, Aly A. Gastric adenocarcinoma of the upper oesophagus: A literature review and case report. Int J Surg Case Report. 2017;30:205-14. doi: 10.1016/j.ijscr.2016.11.014.
  • 10. Ajmal S, Young JS, Ng T. Adenocarcinoma arising from cervical esophageal gastric inlet patch. J Thorac Cardiovasc Surg. 2015;149(6):1664-5. doi: 0rg/10.1016/j.jtcvs.2015.03.050.
  • 11. Vesper I, Schmiegel W, Brechmann T. Equal detection rate of cervical heterotopic gastric mucosa in standard white light, high definition and narrow band imaging endoscopy. Z Gastroenterol. 2015;53(11):1247-54. doi: 10.1055/s.0041-104226.
  • 12. Georges A, Coopman S, Rebeuh J, Molitor G, Rebouissoux L, Dabadie A, et al. Inlet patch: clinical presentation and outcome in children. J Pediatr Gastroenterol Nutr. 2011;52(4):419-23. doi: 10.1097/MPG.0b013e3181f2a913.
  • 13. Weickert U, Wolf A, Schröder C, Autschbach F, Vollmer H. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus. 2011;24(2):63-8. doi: 10.1111/j.1442-2050.2010.01091.x.
  • 14. Fang Y, Chen L, Shen DF, Xu Y, Xia YJ, Li JW, et al. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol. 2014;20(46):17588-94. doi: 10.3748/wjg.v20.i46i17588.
  • 15. Oguma J, Ozawa S, Omori T, Kitagawa Y, Saikawa Y, Mikami S, et al. EMR of a hyperplastic polyp arising in ectopic gastric mucosa in the cervical esophagus: case report. Gastrointest Endosc. 2005;61(2):335-8. doi: 10.1016/S0016-5107(04)02469-1.
  • 16. Ciocalteu A, Popa P, Ionescu M, Gheonea D. Issues and controversies in esophageal inlet patch. World J Gastroenterol. 2019;25(30):4061-73. doi: 10.3748/wjg.v25.i30.4061.
  • 17. Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, Dursun A. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol. 2010;16(1):42-7. doi: 10.3748/wjg.v16.i1.42.
  • 18. Gutierrez O, Akamatsu T, Cardona H, Graham DY, El-Zimaity HMT. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol. 2003;98(6):1266-70. doi: 10.1111/j.1572-0241.2003.07488.x.
  • 19. Tanaka M, Ushiku T, Ikemura M, Shibahara J, Seto Y, Fukayama M. Esophageal adenocarcinoma arising in cervical inlet patch with synchronous Barrett's esophagus-related dysplasia. Pathol Int. 2014;64(8):397-401. doi: 10.1111/pin.12181.
  • 20. Yamada T, Tsuji A, Onoue S, Kaneko M, Tanioka F, Osawa S, et al. Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase). World J Clin Cases. 2017;5(11):403-6. doi: 10.12998/wjcc.v5.i11.403.

Olgular eşliğinde özofagusta lokalize heterotopik gastrik mukozayı (inlet patch) tanıyalım

Year 2020, Volume: 4 Issue: 12, 1219 - 1222, 01.12.2020
https://doi.org/10.28982/josam.820639

Abstract

Amaç: Heterotopik gastrik mukoza olarak da adlandırılan inlet patch sıklıkla proksimal özofagusta lokalizedir. Genellikle asemptomatiktir. Polipoid yapıda seyrek saptanan bu lezyonlar, sıklıkla endoskopik olarak yamasal tarzda izlenir. Literatürde metaplazi-displaziadenokarsinom sekansını takiben malign progresyon gösterebilen az sayıda inlet patch olguları yer almaktadır. Çalışmamızda inlet patch tanılı olgu serimizi endoskopik ve morfolojik özellikleriyle sunmayı amaçladık.
Yöntemler: Çalışma iki klinik üzerinden yürütüldü. Her iki klinikte 2016-2019 yılları arasında özofagusa ait biyopsi materyalleri içinde inlet patch tanısı alan olgular dahil edildi. Olgulara ait preparatlar ve demografik bilgiler tekrar gözden geçirildi.
Bulgular: Özofagus biyopsisi incelenen 4190 olgu içinde 63 olgu (%1,5) inlet patch tanısı aldı. Olguların 34’ü erkek, 29’u kadındı. Olguların yaşları 16 ile 82 arasında değişmekteydi. En sık görüldüğü yaş aralığı 30-50 yaşdı. En sık proksimal özofagusta lokalizeydi (59 olgu). Lezyonların boyutları 0,2-3,5 cm arasında değişmekteydi. Polipoid görünümdeki dört olgudan biri histopatolojik olarak hiperplastik polip tanısı aldı. En sık gözlenen gastrik tip epitel oksintik tipti (29 olgu). Helikobakter pilori dört olguda izlendi. Olgulardan birinde intestinal metaplazi ve düşük dereceli displazi saptandı. Malignite tanısı olan olgumuz yoktu.
Sonuç: Benign bir lezyon olmasına rağmen maligniteye dönüşüm riski nedeniyle inlet patch olgularının önemsenmesi gerekmektedir. Bu nedenle endoskopik incelemede inlet patch olarak saptanan her lezyondan biyopsi alınması, özellikle büyük boyut, ülser gibi farklı klinik tablo sergileyen olguların da yakın klinik takiplerinin yapılması bizlere inlet patchin gerçekte görülme sıklığının ne olduğunu ve en önemlisi gelişen neoplazilerin erken dönemde saptanmasına olanak sağlayacaktır.

References

  • 1. Terada T. Heterotopic gastric mucosa of the gastrointestinal tract: A histopathologic study of 158 cases. Pathol Res Pract. 2011;207(3):148-50. doi: 10.1016/j.prp.2010.12.004.
  • 2. Orizio P, Villanacci V, Bassotti G, Falchetti D, Torri F, Ekema G. Heterotopic gastric mucosa in the cystic duct. Int J Surg Pathol. 2011;19(3):364-5. doi: 10.1177/1066896909337717.
  • 3. Peitz U, Vieth M, Evert M, Arand J, Roessner A, Malfertheiner P. The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett's esophagus. BMC Gastroenterol. 2017;17(1):87. doi: 10.1186/s12876-017-0644-3.
  • 4. Lupu VV, Ignat A, Paduraru G, Mihaila D, Burlea M, Ciubara A. Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report. Medicine . 2015;94(42):e1722. doi: 10.1097/MD.0000000000001722.
  • 5. Mete R, Oran M, Yüksek A, Gürdal SÖ, Coşkunkan U, Aydın U, et al. Yutma güçlüğü ile başvuran inlet patch olgusu. Int J Basic Clin Med. 2013;1(2):120-2. http://hdl.handle.net/20.500.11776/2223.
  • 6. Alagozlu H, Ergun M, Cindoruk M, Unal S, Dumlu S, Poyraz A, et al. The rare presentations of a large polyp and an esophageal carcinoma in heterotopic gastric mucosa: a case series. J Med Case Rep. 2007;127:1-4. doi: 10.1186/1752-1947-1-127.
  • 7. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol. 2013;19(3):331-8. doi: 10.3748/wjg.v19.i3.331.
  • 8. Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol. 2018;9(3):214-20. doi: 10.1136/flgastro-2017-100855.
  • 9. Riddiough GE, Hornby ST, Asadi K, Aly A. Gastric adenocarcinoma of the upper oesophagus: A literature review and case report. Int J Surg Case Report. 2017;30:205-14. doi: 10.1016/j.ijscr.2016.11.014.
  • 10. Ajmal S, Young JS, Ng T. Adenocarcinoma arising from cervical esophageal gastric inlet patch. J Thorac Cardiovasc Surg. 2015;149(6):1664-5. doi: 0rg/10.1016/j.jtcvs.2015.03.050.
  • 11. Vesper I, Schmiegel W, Brechmann T. Equal detection rate of cervical heterotopic gastric mucosa in standard white light, high definition and narrow band imaging endoscopy. Z Gastroenterol. 2015;53(11):1247-54. doi: 10.1055/s.0041-104226.
  • 12. Georges A, Coopman S, Rebeuh J, Molitor G, Rebouissoux L, Dabadie A, et al. Inlet patch: clinical presentation and outcome in children. J Pediatr Gastroenterol Nutr. 2011;52(4):419-23. doi: 10.1097/MPG.0b013e3181f2a913.
  • 13. Weickert U, Wolf A, Schröder C, Autschbach F, Vollmer H. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus. 2011;24(2):63-8. doi: 10.1111/j.1442-2050.2010.01091.x.
  • 14. Fang Y, Chen L, Shen DF, Xu Y, Xia YJ, Li JW, et al. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol. 2014;20(46):17588-94. doi: 10.3748/wjg.v20.i46i17588.
  • 15. Oguma J, Ozawa S, Omori T, Kitagawa Y, Saikawa Y, Mikami S, et al. EMR of a hyperplastic polyp arising in ectopic gastric mucosa in the cervical esophagus: case report. Gastrointest Endosc. 2005;61(2):335-8. doi: 10.1016/S0016-5107(04)02469-1.
  • 16. Ciocalteu A, Popa P, Ionescu M, Gheonea D. Issues and controversies in esophageal inlet patch. World J Gastroenterol. 2019;25(30):4061-73. doi: 10.3748/wjg.v25.i30.4061.
  • 17. Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, Dursun A. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol. 2010;16(1):42-7. doi: 10.3748/wjg.v16.i1.42.
  • 18. Gutierrez O, Akamatsu T, Cardona H, Graham DY, El-Zimaity HMT. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol. 2003;98(6):1266-70. doi: 10.1111/j.1572-0241.2003.07488.x.
  • 19. Tanaka M, Ushiku T, Ikemura M, Shibahara J, Seto Y, Fukayama M. Esophageal adenocarcinoma arising in cervical inlet patch with synchronous Barrett's esophagus-related dysplasia. Pathol Int. 2014;64(8):397-401. doi: 10.1111/pin.12181.
  • 20. Yamada T, Tsuji A, Onoue S, Kaneko M, Tanioka F, Osawa S, et al. Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase). World J Clin Cases. 2017;5(11):403-6. doi: 10.12998/wjcc.v5.i11.403.
There are 20 citations in total.

Details

Primary Language English
Subjects Pathology
Journal Section Research article
Authors

Selma Şengiz Erhan 0000-0001-8810-8806

Sevinc Hallac This is me 0000-0002-6987-0333

Tugba Ipin This is me 0000-0002-1715-6891

Yasemin Gökden 0000-0001-6767-3072

Sibel Sensu 0000-0002-4607-780X

Publication Date December 1, 2020
Published in Issue Year 2020 Volume: 4 Issue: 12

Cite

APA Şengiz Erhan, S., Hallac, S., Ipin, T., Gökden, Y., et al. (2020). Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. Journal of Surgery and Medicine, 4(12), 1219-1222. https://doi.org/10.28982/josam.820639
AMA Şengiz Erhan S, Hallac S, Ipin T, Gökden Y, Sensu S. Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. J Surg Med. December 2020;4(12):1219-1222. doi:10.28982/josam.820639
Chicago Şengiz Erhan, Selma, Sevinc Hallac, Tugba Ipin, Yasemin Gökden, and Sibel Sensu. “Describing the Heterotopic Gastric Mucosa (inlet Patch) Located in the Esophagus With Cases”. Journal of Surgery and Medicine 4, no. 12 (December 2020): 1219-22. https://doi.org/10.28982/josam.820639.
EndNote Şengiz Erhan S, Hallac S, Ipin T, Gökden Y, Sensu S (December 1, 2020) Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. Journal of Surgery and Medicine 4 12 1219–1222.
IEEE S. Şengiz Erhan, S. Hallac, T. Ipin, Y. Gökden, and S. Sensu, “Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases”, J Surg Med, vol. 4, no. 12, pp. 1219–1222, 2020, doi: 10.28982/josam.820639.
ISNAD Şengiz Erhan, Selma et al. “Describing the Heterotopic Gastric Mucosa (inlet Patch) Located in the Esophagus With Cases”. Journal of Surgery and Medicine 4/12 (December 2020), 1219-1222. https://doi.org/10.28982/josam.820639.
JAMA Şengiz Erhan S, Hallac S, Ipin T, Gökden Y, Sensu S. Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. J Surg Med. 2020;4:1219–1222.
MLA Şengiz Erhan, Selma et al. “Describing the Heterotopic Gastric Mucosa (inlet Patch) Located in the Esophagus With Cases”. Journal of Surgery and Medicine, vol. 4, no. 12, 2020, pp. 1219-22, doi:10.28982/josam.820639.
Vancouver Şengiz Erhan S, Hallac S, Ipin T, Gökden Y, Sensu S. Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. J Surg Med. 2020;4(12):1219-22.