Cock Charles, Hamarneh Zaki
Department of Gastroenterology & Hepatology, Flinders Medical Centre.
Department of Gastroenterology & Hepatology, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
Curr Opin Otolaryngol Head Neck Surg. 2019 Dec;27(6):453-462. doi: 10.1097/MOO.0000000000000581.
The purpose of this review is to assess recent literature on the clinical relevance of the gastric inlet patch with particular focus on endoscopic diagnosis and treatment, the relationship of the inlet patch to laryngopharyngeal reflux disease and the association of proximal esophageal adenocarcinoma with inlet patch.
Recent studies suggest endoscopic diagnosis of inlet patch increases with endoscopist awareness (up to 10-fold) and when using enhanced imaging techniques such as narrow band imaging (up to three-fold). The literature remains mixed on the association of inlet patch with laryngopharyngeal symptoms or globus sensation. Studies of endoscopic ablation, using argon plasma coagulation or radiofrequency ablation have shown improved laryngopharyngeal reflux symptom scores posttreatment. Proximal esophageal adenocarcinomas are rare but often associated with inlet patch when they occur. Case studies have described endoscopic resection of malignant lesions related to inlet patch, using endoscopic mucosal resection or submucosal dissection.
Prospective, multicenter studies of symptom association with inlet patch using validated symptom questionnaires and blinded sham-controlled treatments are needed to further clarify the role of such treatments, which to date are limited to a small numbers of centers with a special interest.
本综述旨在评估近期有关胃入口黏膜片临床相关性的文献，特别关注内镜诊断与治疗、入口黏膜片与喉咽反流病的关系以及近端食管腺癌与入口黏膜片的关联。
近期研究表明，随着内镜医师意识的提高（高达10倍）以及使用窄带成像等增强成像技术（高达3倍），入口黏膜片的内镜诊断率有所增加。关于入口黏膜片与喉咽症状或咽部异物感的关联，文献报道不一。使用氩等离子体凝固或射频消融进行内镜消融的研究显示，治疗后喉咽反流症状评分有所改善。近端食管腺癌很少见，但发生时通常与入口黏膜片有关。病例研究描述了使用内镜黏膜切除术或黏膜下剥离术对与入口黏膜片相关的恶性病变进行内镜切除。
需要采用经过验证的症状问卷和盲法假对照治疗进行关于入口黏膜片症状关联的前瞻性、多中心研究，以进一步阐明此类治疗的作用，迄今为止，此类治疗仅限于少数有特殊兴趣的中心。
