Diseases of the Esophagus (2015) 28, 666–672 DOI: 10.1111/dote.12252
Original article
Intentional examination of esophagus by
narrow-band imaging endoscopy increases detection rate
of cervical inlet patch
C.-S. Chung,1,2 C.-K. Lin,1 C.-C. Liang,1 W.-F. Hsu,1 T.-H. Lee1
1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital and 2College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
SUMMARY.
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-narrowband 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.
KEY WORDS: cervical inlet patch, gastroesophageal reflux disease,
