Jason Mark Dunn1, Guiping Sui2, Angela Anggiansah2, Terence Wong2. 1. Department of Gastroenterology, Guy's and St. Thomas's Hospital NHS Trust, London, United Kingdom; Institute for Cancer Genetics and Informatics, Oslo University, Oslo, Norway. 2. Department of Gastroenterology, Guy's and St. Thomas's Hospital NHS Trust, London, United Kingdom.
Abstract
BACKGROUND AND AIMS: The cervical inlet patch (CIP) is an area of heterotopic gastric mucosa at the proximal esophagus, which can secrete both acid and mucus. Attributable symptoms include chronic globus sensation and sore throat. Previous studies have demonstrated improvement in symptoms after ablation using argon plasma coagulation. Our aim was to assess a through-the-scope radiofrequency ablation (RFA) catheter for ablation of symptomatic CIP. METHODS: Ten patients with endoscopically and histologically proven CIP and symptoms of globus or sore throat were included in the study. An ablation protocol of 3 ablations at 12 J/cm2, without removal of coagulated tissue between ablations, was used. A maximum of 2 RFA sessions, 3 months apart, was allowed. A visual analog score was completed at baseline, 6 weeks (on proton pump inhibitor), 3 months (off proton pump inhibitor), and 12 months after treatment. RESULTS: Mean patient age was 56 years (±3 years, standard error of the mean), 60% were men, and 80% were white. Barrett's esophagus was present in 50%. The mean number of CIPs was 2 (range, 1-4) with a median surface area of 2 cm2 (range, .5-14). After a median of 2 treatments, 80% achieved complete endoscopic and histologic resolution, with a mean follow-up of 14 months (range, 12-17). Globus, sore throat, and cough significantly improved from baseline (P < .05). No strictures or buried glands were identified. CONCLUSIONS: This prospective pilot study demonstrates that RFA using a through-the-scope device is safe and effective for treating patients with symptomatic CIP. One-year follow-up data suggest the effect is durable. Crown
BACKGROUND AND AIMS: The cervical inlet patch (CIP) is an area of heterotopic gastric mucosa at the proximal esophagus, which can secrete both acid and mucus. Attributable symptoms include chronic globus sensation and sore throat. Previous studies have demonstrated improvement in symptoms after ablation using argon plasma coagulation. Our aim was to assess a through-the-scope radiofrequency ablation (RFA) catheter for ablation of symptomatic CIP. METHODS: Ten patients with endoscopically and histologically proven CIP and symptoms of globus or sore throat were included in the study. An ablation protocol of 3 ablations at 12 J/cm2, without removal of coagulated tissue between ablations, was used. A maximum of 2 RFA sessions, 3 months apart, was allowed. A visual analog score was completed at baseline, 6 weeks (on proton pump inhibitor), 3 months (off proton pump inhibitor), and 12 months after treatment. RESULTS: Mean patient age was 56 years (±3 years, standard error of the mean), 60% were men, and 80% were white. Barrett's esophagus was present in 50%. The mean number of CIPs was 2 (range, 1-4) with a median surface area of 2 cm2 (range, .5-14). After a median of 2 treatments, 80% achieved complete endoscopic and histologic resolution, with a mean follow-up of 14 months (range, 12-17). Globus, sore throat, and cough significantly improved from baseline (P < .05). No strictures or buried glands were identified. CONCLUSIONS: This prospective pilot study demonstrates that RFA using a through-the-scope device is safe and effective for treating patients with symptomatic CIP. One-year follow-up data suggest the effect is durable. Crown