Intentional examination of esophagus by narrow-band imaging endoscopy increases detection rate of cervical inlet patch

Abstract

Foci of heterotopic gastric mucosa have been identified at different sites in the human body and the most common location is the proximal esophagus which is referred to as cervical inlet patch (CIP). The true prevalence of CIP varies and it is usually incidental findings during endoscopy. Because CIP is always asymptomatic, it was believed to be of little clinical relevance. However, emerging studies have described the acid-secreting characteristics of heterotopic gastric mucosa and associations of CIP with gastroesophageal reflux disease (GERD). In addition, complications such as stricture, fistula, infection, mucosal hyperplasia, and malignant transformation have been reported. In this study, we investigated the prevalence of CIP, its associations with clinical manifestations, and the effect of intentional screening upper esophagus by magnifying endoscopy-narrow-band imaging (ME-NBI) system. Consecutive healthy adults who underwent panendoscopy were separated into two groups. Patients in group I (n = 471) were examined by an endoscopist who intended to find CIPs by ME-NBI. Patients in group II (n = 428) were examined by two endoscopists who were unaware of the study and performed white-light imaging endoscopy. Participants provided questionnaires on GERD-related symptoms. Higher CIP prevalence (11.7% vs. 1.9%, P < 0.0001) and longer duration of esophageal examination (mean ± standard deviation, 17.50 ± 12.40 vs. 15.24 ± 10.78 seconds, P = 0.004) were noted in group I than in group II. Analyzing group I patients revealed the higher prevalences of reflux symptoms (32.7% vs. 18.3%, P = 0.013) and erosive esophagitis (43.6% vs. 25.5%, P = 0.005) in patients with CIP than in those without. CIP was not associated with globus or dysphagia symptoms. More small CIPs (< 5 mm) were detected by ME-NBI than by white-light imaging (85.3% vs. 41.4%, P = 0.001). In conclusion, CIP prevalence was not low under intentional ME-NBI examination of the upper esophagus. The clinical relevance of CIP and its association with GERD require further investigation.

The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett’s esophagus

“…But some studies report prevalences close to this, 10% by Borhan-Manesh et al [18], 11% by Weickert et al [27], 12% by Chung et al [30] using narrow band imaging, 13% by Vesper et al [33] and 14% by Kumagai et al [23]. In an abstract, Ohara et al [52] report even 21%, also using narrow band imaging.…”

Narrowed-spectrum Technologies in Endoscopic Imaging of The Upper Gastrointestinal Tract

“…60 In another study, intentional ME-NBI examination of the upper esophagus resulted in a higher detection of cervical inlet patches compared to standard clinical practice with WLE, (11.7% vs. 1.9%). 61…”

Monitoring the premalignant potential of Barrett's oesophagus'

“…This is actually a cervical inlet patch and is a developmental abnormality. Traditionally, it is thought to occur in around 2% of the population, but with narrow band imaging (NBI) and careful examination, it can be found in more than 10% 7. Inlet patches very rarely have IM and even more rarely develop cancer.…”

“…Traditionally, it is thought to occur in around 2% of the population, but with narrow band imaging (NBI) and careful examination, it can be found in more than 10%. 7 Inlet patches very rarely have IM and even more rarely develop cancer. They may cause globus symptoms and there is a literature developing around ablation to relieve symptoms.…”