A 50-year-old man presented to the hospital with chief complaints of difficulty swallowing solid foods, throat discomfort, and a hoarse voice. Esophagogastroduodenoscopy (EGD) revealed a circumferential cervical inlet patch 16-21 cm from the incisors (Picture 1, 2). The distal end of the inlet patch was stenotic and the scope (GIF-XZ1200; Olympus, Tokyo, Japan) did not pass through (Picture 3). Endoscopic biopsy of the circumferential inlet patch revealed a columnar fundus-type gastric mucosa. Parietal cells were identified, suggesting that gastric acid secretion from the inlet patch caused the distal stenosis (Picture 4). The patient underwent balloon dilation, which improved the difficulty in swallowing solid foods. In addition, the patient's throat discomfort and voice hoarseness improved after treatment with vonoprazan fumarate (20 mg). Most inlet patches are asymptomatic; however, when widespread, laryngopharyngeal reflux and stenotic symptoms may occur owing to gastric acid secretion (1,2). This condition is not well recognized and requires caution when performing EGD.
Picture 1.
Picture 2.
Picture 3.
Picture 4.
The authors state that they have no Conflict of Interest (COI).
References
- 1.Shimamura Y, Winer S, Marcon N. A giant circumferential inlet patch with acid secretion causing stricture. Clin Gastroenterol Hepatol 15: A22-A23, 2017. [DOI] [PubMed] [Google Scholar]
- 2.Brechmann T, Mühlenkamp M, Schmiegel W, Viebahn B. Argon plasma coagulation of gastric inlet patches of the cervical esophagus relieves vocal and respiratory symptoms in selected patients. Dig Dis Sci 68: 1936-1943, 2023. [DOI] [PubMed] [Google Scholar]