Esophageal Inlet Patch Causing Acute Dysphagia and Food Impaction

CASE REPORT

Department of Gastroenterology, Virginia Tech Carilion School of Medicine

Final Diagnosis

Esophageal inlet patch causing stricture and food impaction, managed with endoscopic foreign body removal and subsequent dilation.

Patient Demographics

A 52-year-old female patient.

Clinical History

The patient presented with acute dysphagia. Upper endoscopy was indicated to evaluate the cause of acute dysphagia.

Endoscopic Findings

1. A 20 x 30 mm esophageal inlet patch was identified.
2. A distal fibrotic stricture was noted in the esophagus.
3. Distal to the fibrotic stricture, a piece of chicken was impacted in the midesophagus.
4. Another esophageal stricture was observed distal to the food impaction.

Endoscopic Technique

1. The impacted chicken meat was removed using a distal transparent cap attached to the endoscope.
2. Following the initial procedure, the patient was initiated on proton pump inhibitors.
3. A subsequent upper endoscopy was performed where esophageal dilation was carried out up to 16 mm.

Discussion

An inlet patch, also known as esophageal heterotopic gastric mucosal patch or cervical inlet patch, is a common but often overlooked area of ectopic gastric mucosa found in the upper esophagus. It is present in approximately 3 to 5% of patients undergoing upper endoscopy. While most patients are asymptomatic, some may experience symptoms such as dysphagia, cough, globus sensation, or hoarseness. Treatment for symptomatic inlet patch involves ablating the tissue, typically using techniques like argon plasma coagulation or radiofrequency ablation. Proton pump inhibitors are beneficial in reducing acid secretion from the ectopic gastric mucosa. Moreover, patients with associated esophageal strictures, as in this case, benefit from endoscopic dilation. This case highlights an uncommon presentation of an inlet patch causing esophageal stricture and acute food impaction.

Key Learning Points

1. Esophageal inlet patches, while often asymptomatic, can cause significant symptoms including dysphagia and stricture formation.
2. Food impaction can occur in the setting of an underlying esophageal stricture caused by an inlet patch.
3. Endoscopic removal of foreign bodies and subsequent esophageal dilation are effective treatments for managing symptomatic inlet patch-associated strictures.
4. Proton pump inhibitor therapy can help mitigate acid-related complications from ectopic gastric mucosa.

References

1. Behrens C, Yen NPP. Esophageal patch. Radiology Research and Practice. 2011;2011:2460890.
2. Bindlish S, Murali R. Inlet patch stricture: a case report. American Journal of Gastroenterology. 2010;105:23.
3. Bajbpuj, M et aI. Argon plasma coagulation of cervical heterotopic gastric mucosa as an alternative treatment for globus sensation. Gastroenterology. 2009;137:440–4.