Özofageal inlet patch: Hastaların demografik ve endoskopik karakteristikleri ve litaratürün gözden geçirilmesi

Yıl 2021, Cilt: 20 Sayı: 2, 117 - 122, 26.08.2021

İbrahim Köker Nurhan Şahin

https://doi.org/10.17941/agd.982255

Öz

Giriş ve Amaç: Özofageal inlet patch yutkunma zorluğunda, laringofarengeal reflü semptomlarında ve nadir de olsa proksimal özofagus adenokarsinom etiyolojisinde önemlidir. Amacımız endoskopik değerlendirme sırasında özofageal inlet patch tespit ettiğimiz hastaların endoskopik ve demografik özelliklerini değerlendirmek ve literatürle karşılaştırmaktı. Gereç ve Yöntem: Ocak 2017-Ocak 2021 tarihleri arasında üst gastrointestinal endoskopik değerlendirmede özofagusta inlet patch saptanan hastaların yaş, cinsiyet, inlet patch boyutları ve sayısı ile hastalarda saptanan diğer endoskopik bulguları değerlendirdik. Bulgular: Toplam 53 hastanın 36’sı (%68) kadındı. Yaş ortalaması 46.3 ± 15.8, değer aralığı (19-83) yıldı. Hastaların 13’ü inlet patch tanısı açısından semptomatikti. Özofageal inlet patch median boyutları kadınlarda 7.0 mm, değer aralığı (4-30) iken; erkeklerde 8 mm, değer aralığını (5-20) saptadık. Her iki cinsiyette median inlet patch sayısı 1, değer aralığı kadınlarda 1-3, erkeklerde 1-2 idi. Hastaların 29’unda (%54.7) forseps biyopsisi yapılabildi. Hastaların 45’inde (%84.9) ilave özofagus patolojisi saptamadık, 39’unda (%73.5) alt özofagus sfinkteri normal, 14’ünde (%26.4) incompetant, 1 (%1.8) hastada ise Hiatal Herni saptadık. 29 (%55.7) hastada endoskopik antral gastrit bulgusu saptadık. 22 endoskopik biyopsinin 12’sinde (%54.5) Helicobacter pylori pozitifti. Ayrıca 2 (%3.7) hastada özofageal inlet patch distal özofagus yerleşimli olarak tespit edildi. Sonuç: Özofageal inlet patch kadınlarda daha sıktı, gastroözofageal reflü hastalığı ile ilişkisizdi ve çoğu hasta asemptomatikti. Özofageal inlet patch’lerin median boyutları 8 mm, değer aralığı (4-30) idi, kadın erkek arasında fark saptamadık. İnlet patch boyutları ile semptom varlığı arasında da ilişki kuramadık. Biyopsi alınan inlet patchlerin hiçbirisinde malignite bulgusuna rastlamadık.

Anahtar Kelimeler

Endoskopi, inlet patch, heterotopik gastrik mukoza

Esophageal inlet patch: Demographic and endoscopic characteristics of patients and review of the literature

Öz

Background and Aims: An esophageal inlet patch is crucial in swallowing difficulty, laryngopharyngeal reflux symptoms, and rarely in the etiology of proximal esophagus adenocarcinoma. We aimed to evaluate the endoscopic and demographic features of patients with esophageal inlet patch during endoscopic evaluation and compare them with those of the literature. Material and Method: Between January 2017 and January 2021, we evaluated the age, gender ratio, inlet patch size, and number along with the other endoscopic findings in patients with proximal esophageal inlet patch. Results: Overall, 53 patients (women, 36 (68%); mean age, 46.3 ± 15.8 years; range, 19–83 years) were included the study. Only 13 patients (24.5%) had specific symptoms of esophageal inlet patch. The median esophageal inlet patch size was 7.0 mm in women (range, 4–30), while it was 8 mm (range, 5–20) in men. The median inlet patch number was 1 in both sexes (range, 1–3 in women, 1–2 in men). Forceps biopsy was possible in 30 (56.6%) patients. We found no additional esophageal pathology in 45 (84.9%) patients, normal lower esophageal sphincter in 39 (73.5%), incompetent lower esophageal sphincter in 14 (26.4%), hiatal diaphragmatic hernia in 1 (1.8%), and endoscopic antral gastritis in 29 (55.7%) patients. Twelve (54.5%) of 22 endoscopic biopsies were positive for Helicobacter pylori. We detected esophageal inlet patch in the distal esophagus in 2 (3.7%) patients. Conclusion: Esophageal inlet patch was more common in women, unrelated to gastroesophageal reflux disease, and most patients were asymptomatic, with a median size of 8 mm (range, 4–30), with no gender difference. Moreover, inlet patch size was not associated with presence of symptoms. Evidence of malignancy in the biopsied inlet patches was not observed.

Anahtar Kelimeler

Endoscopy, inlet patch, heterotopic gastric mucosa

Kaynakça

• 1. Schumidt FFA. De mammlium oesophage atque ventriculo, Inaugural dissertation. Bathenea: Halle, 1805.
• 2. Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol 2018;9:214-20.
• 3. Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol 2013;19:331-8.
• 4. Akbayır N, Sökmen HM, Çalış AB, et al. Heterotopic gastric mucosa in the cervical esophagus: Could this play a role in the pathogenesis of laryngopharyngeal reflux in a subgroup of patients with posterior laryngitis? Scand J Gastroenterol 2005;40:1149-56.
• 5. Galmiche JP, Clouse RE, Balint A, et al. Functional esophageal disorders. Gastroenterology 2006;130:1459-65.
• 6. Aziz Q, Fass R, Gyawali CP, et al. Esophageal disorders. Gastroenterology 2016;150:1368-79.
• 7. Yamada T, Tsuji A, Onoue 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;5:403-6.
• 8. Meining A, Bajbouj M. Gastric inlet patches in the cervical esophagus: what they are, what they cause, and how they can be treated. Gastrointest Endosc 2016;84:1027-9.
• 9. 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;137:440-4.
• 10. 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;88:165-71.
• 11. Ciocalteu A, Popa P, Ionescu M, Gheonea DI. Issues and contraversies in esophageal inlet patch. World J Gastroenterol 2019;25:4061-73.
• 12. Sahin G, Adas G, Koc B, et al. Is cervical inlet patch important clinical problem ? Int J Biomed Sci 2014;10:129-35.
• 13. Korkut E, Bektas M, Savas B, et al. Awareness of the endoscopist affects detection rate of heterotopic gastric mucosa in esophagus. Indian J Gastroenterol 2009;28:75-6.
• 14. Akbayır N, Alkım C, Erdem L, et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): Endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol 2004;19:891-6.
• 15. Mungan Z. Is it Barrett’s esophagus or gastric heterotopia? Case Rep Gastroenterol 2014;8:282-5.
• 16. Avidan B, Sonnenberg A, Chejfec G, Schnell TG, Sontag S. Is there a link between cervical inlet patch and Barrett’s esophagus? Gastrointest Endosc 2001;53:717-21.
• 17. Neumann WL, Lujan GM, Genta RM. Gastric heterotopia in the proximal oesophagus (“inlet patch”): Association with adenocarcinomas arising in Barrett mucosa. Dig and Liver Dis 2012;44:292-6.
• 18. Chung CS, Lin CK, Liang CC, Hsu WF, Lee TH. Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch. Dis of Esoph 2015;28:666-72.
• 19. Hori K, Kim Y, Sakurai J, et al. Non-erosive reflux disease rather than cervical inlet patch involves globus. J Gastroenterol 2010;45:1138-45.
• 20. Yüksel İ, Üsküdar O, Köklü S, et al. Inlet patch: Associations with endoscopic findings in the upper gastrointestinal system. Scand J Gastroenterol 2008;43:910-4.
• 21. Alagozlu H, Ergun M, Cindoruk M, et al. The rare presentations of a large polyp and an esophageal carcinoma in heterotropic gastric mucosa: a case series. J of Med Case Rep 2007;1:127.
• 22. Hoshino A, Otuka Y, Nara S, Harihara Y, Konishi T. A case of primary adenocarcinoma of the cervical esophagus arising from the ectopic gastric mucosa. Esophagus 2007;4:83-6.
• 23. Ajmal S, Young JS, Ng T. Adenocarcinoma arising from cervical esophageal gastric inlet patch. J Thorac Cardiovasc Surg 2015;149:1664-5.
• 24. Orosey M, Amin M, Cappell MS. A 14- year study of 398 esophageal adenocarcinomas diagnosed among 156,256 EGDs performed at two large hospitals: An inlet patch is proposed as a significant risk factor for proximal esopohageal adenocarcinoma. Dig Dis Sc 2018;63:452-65.