Gastric Heterotopia in the Proximal Esophagus (“Inlet Patch”): Association with Adenocarcinomas Arising in Barrett Mucosa
William L Neumann, Giovanni M Lujan, Robert M Genta. Caris Research Institute, Irving, TX; University of Texas Southwestern Medical Center at Dallas, Dallas, TX
Background: The prevalence of inlet patches and their associations have been studied in tertiary care facilities; data generated from outpatient clinics are lacking. We designed this study to assess prevalence, demographics, and associated clinicopathologic features of inlet patches in patients who had esophagogastroduodenoscopy (EGD) in US outpatient settings.
Design: Using a large pathology database that includes biopsy specimens from US outpatient centers and relevant clinical and endoscopic information, we extracted pertinent data from patients who underwent EGD with biopsy between 1/2008 and 12/2010. Patients with inlet patch were identified by diagnostic codes and free-text searches. Controls were all patients who had EGD during the same period but no diagnosis of gastric heterotopia in the esophagus.
Results: Inlet patch was found in 870 (0.18%) of 487,229 unique patients (median age 56 years, 52.8% male) and was more common in males (p<0.0001). Dysphagia and odynophagia, globus, and upper respiratory symptoms were significantly more common in patients with inlet patch than in those without. The impression of a lesion in the upper esophagus was conveyed to the pathologist in 724 of the 870 patients (sensitivity 83.2%) with inlet patch. The inlet patch consisted of oxyntic mucosa lined by foveolar-type gastric epithelium; intestinal metaplasia was seen in 9 cases (1.0%) and dysplasia in none. H. pylori gastritis was less prevalent in patients with inlet patches than in controls (4.7% vs. 9.0%; p<0.001). Barrett mucosa (BM) was more common in men with inlet patches than in those without (15% vs. 11%; p<0.001). Of 31,401 patients with BM and no inlet patch, 654 (2.1%) had low-grade dysplasia; 342 (1.1%) had high-grade dysplasia; and 205 (0.7%) had adenocarcinoma. In comparison, of the 84 patients with both BM and an inlet patch, 1 (1.2%) had high-grade dysplasia, 1 (1.2%) had low-grade dysplasia, and 3 (3.6%) had adenocarcinoma (OR 5.64, 95% CI 1.77 - 18.0; p<0.001).
Conclusions: The prevalence of inlet patches in a tertiary care setting was lower than reported in prospective studies. Inlet patches were significantly associated with male gender, dysphagia, upper respiratory complaints, globus, Barrett mucosa, and adenocarcinomas arising in Barrett esophagus. Further studies will be needed to determine if patients with inlet patches and Barrett mucosa benefit from increased surveillance.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 111, Monday Morning