Endoscopic diagnosis and treatment of inlet patch: Justification, techniques, and results

Esophageal gastric inlet patches (EGIPs) comprise an island of heterotopic gastric columnar epithelium in the cervical esophagus with a reported prevalence of up to 10%. Usually the diagnosis is made by chance in the course of an upper gastrointestinal endoscopy. After histopathologic examination EGIPs can be classified as oxyntic (mucosal glands contain parietal cells), mucoid type (mucosa is composed solely of glands with mucous cells), or mixed type (presence of both: glands with parietal cells and glands of mucous cells). Despite their overall low incidence of clinically relevant conditions, EGIPs seem to be a significant entity. Few individuals with EGIPs report symptoms of globus sensations, dysphagia, hoarseness, or chronic cough that are often misinterpreted as an atypical manifestation of gastroesophageal reflux disease. It is known that these symptoms significantly compromise the patients' quality of life. Therefore, therapy should be initiated. However, proton pump inhibitors' response seems to be poor in these patients. We were able to show that an interventional ablative endoscopic therapy by argon plasma coagulation can be a safe and effective procedure. However, further researches are required to better understand the clinical significance of EGIPs and their association to symptoms.