Opinion Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2019; 25(30): 4061-4073
Published online Aug 14, 2019. doi: 10.3748/wjg.v25.i30.4061
Issues and controversies in esophageal inlet patch
Adriana Ciocalteu, Petrica Popa, Mircea Ionescu, Dan Ionut Gheonea
Adriana Ciocalteu, Petrica Popa, Dan Ionut Gheonea, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova 200349, Romania
Mircea Ionescu, Department of Anesthesiology and Intensive Care, Emergency County Hospital of Craiova, Craiova 200642, Romania
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Petrica Popa, MD, PhD, Doctor, Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Petru Rares 2, Craiova 200349, Romania. popa.petrica92@yahoo.com
Telephone: +40-74-8374019 Fax: +40-251-310287
Received: March 12, 2019
Peer-review started: March 12, 2019
First decision: June 10, 2019
Revised: June 24, 2019
Accepted: July 5, 2019
Article in press: July 5, 2019
Published online: August 14, 2019
Abstract

The proximal esophagus is rarely examined, and its inspection is often inadequate. Optical chromoendoscopy techniques such as narrow band imaging improve the detection rate of inlet patches in the proximal esophagus, a region in which their prevalence is likely underestimated. Various studies have reported correlations between these esophageal marks with different issues such as Barrett’s esophagus, but these findings remain controversial. Conflicting reports complicate the process of interpreting the clinical features of esophageal inlet patches and underestimate their importance. Unfortunately, the limited clinical data and statistical analyses make reaching any conclusions difficult. It is hypothesized that inlet patches are correlated with various esophageal and extraesophageal symptoms, diagnoses and the personalized therapeutic management of patients with inlet patches as well as the differential diagnosis for premalignant lesions or early cancers. Due to its potential underdiagnosis, there are no consensus guidelines for the management and follow up of inlet patches. This review focuses on questions that were raised from published literature on esophageal inlet patches in adults.

Keywords: Inlet patch, Ectopic gastric mucosa, Heterotopic gastric mucosa, Esophageal cancer, Narrow band imaging, Optical chromoendoscopy, Cervical esophagus, Functional dyspepsia, Barrett’s esophagus, Helicobacter pylori

Core tip: Esophageal inlet patches were largely considered to be either asymptomatic or relatively unimportant. More recently, an increasing array of documented symptoms have been correlated with these esophageal lesions, which have made them a controversial subject. Presently, there are no standard guidelines for the management of symptomatic heterotopic gastric mucosa of the esophagus. Specifically, diagnosing the condition through the use of longer scope withdrawal times paired with the routine use of optical chromoendoscopy in the cervical esophagus could be useful for further exploring the significance of inlet patches.