title: 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.
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.|College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
authors: C-S
authors: CS
authors: Chung
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors: C-K
authors: CK
authors: Lin
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors: C-C
authors: CC
authors: Liang
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors: W-F
authors: WF
authors: Hsu
authors: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan.
authors: T-H
authors: TH
authors: Lee
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002828:Choristoma / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D016145:Endoscopy, Digestive System / Q000379:methods / Q000706:statistics & numerical data*; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005753:Gastric Mucosa; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology; D064368:Healthy Volunteers; D006801:Humans; D008297:Male; D008875:Middle Aged; D062048:Narrow Band Imaging / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: cervical inlet patch; gastroesophageal reflux disease; heterotopic gastric mucosa; narrow-band imaging