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

Abstract

BackgroundThe previously reported prevalence of gastric heterotopia in the cervical esophagus, also termed inlet patch (IP), varies substantially, ranging from 0.18 to 14%. Regarding cases with adenocarcinoma within IP, some experts recommend to routinely obtain biopsies from IP for histopathology. Another concern is the reported relation to Barrett’s esophagus. The objectives of the study were to prospectively determine the prevalence of IP and of preneoplasia within IP, and to investigate the association between IP and Barrett’s esophagus.Methods372 consecutive patients undergoing esophagogastroduodenoscopy were carefully searched for the presence of IP. Biopsies for histopathology were targeted to the IP, columnar metaplasia of the lower esophagus, gastric corpus and antrum. Different definitions of Barrett’s esophagus were tested for an association with IP.ResultsAt least one IP was endoscopically identified in 53 patients (14.5%). Histopathology, performed in 46 patients, confirmed columnar epithelium in 87% of cases, which essentially presented corpus and/or cardia-type mucosa. Intestinal metaplasia was detected in two cases, but no neoplasia. A previously reported association of IP with Barrett’s esophagus was weak, statistically significant only when short segments of cardia-type mucosa of the lower esophagus were included in the definition of Barrett’s esophagus.ConclusionsThe prevalence of IP seems to be underestimated, but preneoplasia within IP is rare, which does not support the recommendation to regularly obtain biopsies for histopathology. Biopsies should be targeted to any irregularities within the heterotopic mucosa. The correlation of IP with Barrett’s esophagus hints to a partly common pathogenesis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12876-017-0644-3) contains supplementary material, which is available to authorized users.

Digestive findings that do not require endoscopic surveillance – Reducing the burden of care: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement

“…No other guidelines specifically address the management of an inlet patch. Recent prospective cohort studies confirm that malignancy is exceptional and do not support regular biopsy or surveillance unless mucosal irregularities are seen [19].…”

Issues and controversies in esophageal inlet patch

“…The previously reported prevalence of IPs in the proximal esophagus ranges from 0.18% to 14% in endoscopic studies[11].…”

“…The lack of studies with long-term follow-ups for IP might be a source of this bias. Other authors such as Peitz et al[11] have also considered that the prevalence of IPs is underestimated, making a correlation with advanced cervical esophageal cancer difficult. Due to the rare incidence of preneoplasia reported for IP, the authors do not support the routine biopsy to determine its histopathology, but rather targeted biopsies should be considered whenever any irregularities within the area are observed.…”

The microscopic anatomy of the esophagus including the individual layers, specialized tissues, and unique components and their responses to injury

“…In a recent prospective endoscopy study, Peitz et al . reported a prevalence of 14.5% (54/372); when this same group looked back at nearly 10,000 of their prior upper endoscopies, it had been documented in only 0.5% . A few prospective studies have compared the prevalence in the operator aware (i.e., endoscopist with knowledge that the purpose of the study is to determine inlet patch prevalence) versus operator unaware settings, with the prevalence typically six times higher in the former .…”