Examination of the aero-digestive tract during routine endoscopy

Abstract

I read with interest the recent publication by Katsinelos et al. on examination of the laryngopharyngeal area during routine upper gastrointestinal (GI) endoscopy [ [1] Katsinelos P. Kountouras J. Chatzimavroudis G. et al. Should inspection of the laryngopharyngeal area be part of routine upper gastrointestinal endoscopy? A prospective study. Dig Liver Dis. 2009; 41: 283-288 Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar ]. Despite the overall low yield, they highlighted an important aspect of upper GI endoscopy examination that is commonly neglected. They also showed it can be done in most cases without causing additional discomfort to the patient. However, there is another area that deserves attention. The proximal portion of the esophagus, just beyond the upper esophageal sphincter is the other commonly neglected area. Abnormal or pathological findings are uncommon but may account for patients’ symptoms. Cervical inlet patch (CIP) is probably the most commonly encountered abnormality in this area with incidence ranging from 0.29 to 10% in endoscopic studies [ 2 Maconi G. Pace F. Vago L. Carsana L. Bargiggia S. Bianchi Porro G. Prevalence and clinical features of heterotopic gastric mucosa in the upper oesophagus (inlet patch). Eur J Gastroenterol Hepatol. 2000; 12: 745-749 Crossref PubMed Scopus (82) Google Scholar , 3 Baudet J.S. Alarcón-Fernández O. Sánchez Del Río A. Aguirre-Jaime A. León-Gómez N. Heterotopic gastric mucosa: a significant clinical entity. Scand J Gastroenterol. 2006; 41: 1398-1404 Crossref PubMed Scopus (28) Google Scholar , 4 Borhan-Manesh F. Farnum J.B. Incidence of heterotopic gastric mucosa in the upper oesophagus. Gut. 1991; 32: 968-972 Crossref PubMed Scopus (128) Google Scholar ]. Similar to the Meckel's diverticulum, CIP contains heterotopic gastric mucosal tissue which can produce acid secretion. Although asymptomatic in most cases, patients with CIP have been shown to have more laryngopharyngeal reflux (LPR) symptoms [ [5] Akbayir N. Alkim C. Erdem L. et al. Heterotopic gastric mucosa in the cervical esophagus (inlet patch): endoscopic prevalence, histological and clinical characteristics. J Gastroenterol Hepatol. 2004; 19: 891-896 Crossref PubMed Scopus (69) Google Scholar ]. Since reporting our own experience with CIP, I now routinely examine the proximal esophagus, especially in patients with LPR symptoms with reasonable yield of CIP detection [ [6] Chong V.H. Jalihal A. Cervical inlet patch: case series and literature review. South Med J. 2006; 99: 865-869 Crossref PubMed Scopus (20) Google Scholar ].