Radiofrequency Ablation of Symptomatic Heterotopic Gastric Inlet Patch Using the Channel RFA Endoscopic Catheter

Abstract

Gastric inlet patches (GIP) of the esophagus are areas comprised of heterotopic gastric columnar epithelium located in the cervical esophagus. Most cases of GIP remain asymptomatic and are discovered incidentally on routine endoscopy, with a prevalence of 0.3% to 10%. In patients who are symptomatic, globus and dysphagia are the most common associated symptoms. Radiofrequency ablation (RFA) therapy has been tried in symptomatic patients with GIP with limited success in eliminating symptoms, and the role of RFA in this group of patients is still evolving. Herein we report on the use of the novel, channel RFA endoscopic catheter to perform RFA and treat symptomatic GIP. A 53 year-old male presented with significant globus and dysphagia symptoms, which had been progressively worsening for the past 2 years. Endoscopy revealed a giant, circumferential GIP, which measured 3 cm in length (Figure 1- Left). The GIP was located close to the upper esophageal sphincter, and had no visible lesions. A single biopsy was taken from the GIP, and histopathology confirmed heterotopic gastric cardia type mucosa with no metaplasia. Subsequently the patient underwent RFA of the GIP using the Through the Scope Channel RFA Endoscopic Catheter (Barrx™, Covidien, MA, USA) for ablation (Figure 1- Right). The catheter, consisting of a 15.7 mm x 7.5 mm transparent electrode array, was easily passed through the 2.8 mm diameter working channel of the endoscope. The GIP could be easily targeted, and effective ablation was performed. Post-procedure the patient had an uneventful recovery. Repeat endoscopy 3 months after RFA revealed grossly normal epithelium in the proximal esophagus, without residual GIP (Figure 2). A random biopsy of the previously affected area was obtained, and histological evaluation demonstrated complete eradication of the GIP. The patient was also evaluated subjectively with a quality of life questionnaire related to his symptoms from GIP. His scores improved from 180 to 207 after treatment with RFA, demonstrating a significantly decreased symptom burden, and improved perception of quality of life. RFA was used successfully in the treatment of symptomatic GIP, with biopsy proven eradication, as well as subjective improvement in quality of life. Due to its thinner diameter, and novel through-thescope design, RFA was feasible with the advantages of transparency, as well as rotatory function for best apposition to the targeted area.Figure 1Figure 2