Brief Article
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World J Gastroenterol. Jan 7, 2014; 20(1): 242-249
Published online Jan 7, 2014. doi: 10.3748/wjg.v20.i1.242
Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images
Chi-Liang Cheng, Cheng-Hui Lin, Nai-Jen Liu, Jui-Hsiang Tang, Yen-Lin Kuo, Yi-Ning Tsui
Chi-Liang Cheng, Yen-Lin Kuo, Yi-Ning Tsui, Department of Gastroenterology, Zhongli Evergreen Hospital, Taoyuan 320, Taiwan
Cheng-Hui Lin, Nai-Jen Liu, Jui-Hsiang Tang, Department of Digestive Therapeutic Endoscopy, Chang Gung Hospital and Chang Gung University, Taoyuan 320 , Taiwan
Author contributions: All authors contributed significantly to the paper; Cheng CL, Lin CH and Liu NJ contributed to the study design and writing of the manuscript; Cheng CL, Kuo YL and Tsui YN contributed to patient enrollment and the endoscopic procedure; Cheng CL contributed to editing of the manuscript; Tang JH contributed to drafting of the figures and data analysis.
Correspondence to: Chi-Liang Cheng, MD, Department of Gastroenterology, Zhongli Evergreen Hospital,150 Huan-Zhong East Rd., Taoyuan 320, Taiwan. chiliang.cheng@gmail.com
Telephone: +886-3-4631230-1902 Fax: +886-3-4630150
Received: May 29, 2013
Revised: August 23, 2013
Accepted: September 16, 2013
Published online: January 7, 2014
Abstract

AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).

METHODS: A prospective study with a total of 760 patients receiving a CI examination (mean age 51.6 years; 47.8% male) and 760 patients undergoing NBI examination (mean age 51.2 years; 45.9% male). The size of HGM was classified as small (1-5 mm), medium (6-10 mm), or large (> 1 cm). A standardized questionnaire was used to obtain demographic characteristics, social habits, and symptoms likely to be related to cervical esophageal HGM, including throat symptoms (globus sensation, hoarseness, sore throat, and cough) and upper esophageal symptoms (dysphagia and odynophagia) at least 3 mo in duration. The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.

RESULTS: Cervical esophageal HGM was found in 36 of 760 (4.7%) and 63 of 760 (8.3%) patients in the CI and NBI groups, respectively (P = 0.007). The NBI mode discovered significantly more small-sized HGM than CI (55% vs 17%; P < 0.0001). For the 99 patients with cervical esophageal HGM, biopsies were performed in 56 patients; 37 (66%) had fundic-type gastric mucosa, and 19 had antral-type mucosa. For the clinicopathological classification, 77 patients (78%) were classified as HGM I (asymptomatic carriers); 21 as HGM II (symptomatic without morphologic changes); and one as HGM III (symptomatic with morphologic change). No intraepithelial neoplasia or adenocarcinoma was found.

CONCLUSION: NBI endoscopy detects more cervical esophageal HGM than CI does. Fundic-type gastric mucosa constitutes the most common histology. One-fifth of patients have throat or dysphagic symptoms.

Keywords: Cervical esophagus, Heterotopic gastric mucosa, Endoscopic diagnosis, Narrow-band imaging, Conventional imaging

Core tip: This prospective study demonstrated the diagnostic yield of narrow-band illumination in the evaluation of cervical esophageal heterotopic gastric mucosa and provided clinicopathological data indicating that most heterotopic gastric mucosa had fundic-type gastric mucosa, with 22% of patients being symptomatic.