Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images

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; Conventional imaging; Endoscopic diagnosis; Heterotopic gastric mucosa; Narrow-band imaging.

Figures

Figure 1

Endoscopic images of cervical esophageal heterotopic gastric mucosa. A: Conventional imaging (CI) image of a typical heterotopic gastric mucosa (HGM) patch; B: Narrow-band imaging (NBI) appears to increase contrast and enhance the mucosal details between the columnar and squamous epithelia; C: Single HGM was found by CI image; D: In NBI contrast, additional small HGM was noted superior to the medium HGM; E: CI image in a patient with circumferential HGM and esophageal stenosis; F: With NBI, the columnar mucosa appears dark brown, and the squamous epithelia, light green. This sharp contrast of coloration aids in the detection of circumferential lesions.