Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases



ınlet patch, esophagus, polyp, Dysplasia


Aim: The inlet patch, also called as the heterotopic gastric mucosa, is often located in proximal esophagus and is generally asymptomatic. These lesions are rarely polypoid and mostly have a patchy pattern. In the literature, there are only few cases of inlet patches that show a malignant progression following a metaplasia- dysplasia- adenocarcinoma sequence. In our study, we aimed to present the endoscopic and morphological features of our case series. Methods: The study, which was conducted in two clinics, included the inlet patch cases diagnosed in esophagus biopsy materials between 2016 and 2019. The slides and the demographic data of the cases were re-analyzed. Results: Among 4190 cases whose esophageal biopsies were examined, 63 inlet patches (1.5%) were diagnosed. Thirty four cases were male and 29 were female. Age range was 16-82 years. The cases were mostly located in proximal esophagus and the size of the lesions ranged between 0.2-3.5 cm. One of the four cases with polypoid appearance was microscopically diagnosed as a hyperplastic polyp. The most common gastric type epithelium was the oxyntic type. Helicobacter pylori was observed in four cases, and intestinal metaplasia and low-grade dysplasia were observed in one. No malignancy was diagnosed in our series. Conclusion: Although benign, the inlet patch is significant due to its risk of progression to malignancy. Thus, obtaining biopsies from each lesion endoscopically considered as inlet patch is recommended. This will help determine the precise incidence of the inlet patch and more importantly, identify neoplasia earlier.


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Terada T. Heterotopic gastric mucosa of the gastrointestinal tract: A histopathologic study of 158 cases. Pathol Res Pract. 2011;207(3):148-50. doi: 10.1016/j.prp.2010.12.004.

Orizio P, Villanacci V, Bassotti G, Falchetti D, Torri F, Ekema G. Heterotopic gastric mucosa in the cystic duct. Int J Surg Pathol. 2011;19(3):364-5. doi: 10.1177/1066896909337717.

Peitz U, Vieth M, Evert M, Arand J, Roessner A, Malfertheiner P. The prevalence of gastric heterotopia of the proximal esophagus is underestimated, but preneoplasia is rare - correlation with Barrett's esophagus. BMC Gastroenterol. 2017;17(1):87. doi: 10.1186/s12876-017-0644-3.

Lupu VV, Ignat A, Paduraru G, Mihaila D, Burlea M, Ciubara A. Heterotopic Gastric Mucosa in the Distal Part of Esophagus in a Teenager: Case Report. Medicine . 2015;94(42):e1722. doi: 10.1097/MD.0000000000001722.

Mete R, Oran M, Yüksek A, Gürdal SÖ, Coşkunkan U, Aydın U, et al. Yutma güçlüğü ile başvuran inlet patch olgusu. Int J Basic Clin Med. 2013;1(2):120-2.

Alagozlu H, Ergun M, Cindoruk M, Unal S, Dumlu S, Poyraz A, et al. The rare presentations of a large polyp and an esophageal carcinoma in heterotopic gastric mucosa: a case series. J Med Case Rep. 2007;127:1-4. doi: 10.1186/1752-1947-1-127.

Chong VH. Clinical significance of heterotopic gastric mucosal patch of the proximal esophagus. World J Gastroenterol. 2013;19(3):331-8. doi: 10.3748/wjg.v19.i3.331.

Rusu R, Ishaq S, Wong T, Dunn JM. Cervical inlet patch: new insights into diagnosis and endoscopic therapy. Frontline Gastroenterol. 2018;9(3):214-20. doi: 10.1136/flgastro-2017-100855.

Riddiough GE, Hornby ST, Asadi K, Aly A. Gastric adenocarcinoma of the upper oesophagus: A literature review and case report. Int J Surg Case Report. 2017;30:205-14. doi: 10.1016/j.ijscr.2016.11.014.

Ajmal S, Young JS, Ng T. Adenocarcinoma arising from cervical esophageal gastric inlet patch. J Thorac Cardiovasc Surg. 2015;149(6):1664-5. doi: 0rg/10.1016/j.jtcvs.2015.03.050.

Vesper I, Schmiegel W, Brechmann T. Equal detection rate of cervical heterotopic gastric mucosa in standard white light, high definition and narrow band imaging endoscopy. Z Gastroenterol. 2015;53(11):1247-54. doi: 10.1055/s.0041-104226.

Georges A, Coopman S, Rebeuh J, Molitor G, Rebouissoux L, Dabadie A, et al. Inlet patch: clinical presentation and outcome in children. J Pediatr Gastroenterol Nutr. 2011;52(4):419-23. doi: 10.1097/MPG.0b013e3181f2a913.

Weickert U, Wolf A, Schröder C, Autschbach F, Vollmer H. Frequency, histopathological findings, and clinical significance of cervical heterotopic gastric mucosa (gastric inlet patch): a prospective study in 300 patients. Dis Esophagus. 2011;24(2):63-8. doi: 10.1111/j.1442-2050.2010.01091.x.

Fang Y, Chen L, Shen DF, Xu Y, Xia YJ, Li JW, et al. Prevalence, histologic and clinical characteristics of heterotopic gastric mucosa in Chinese patients. World J Gastroenterol. 2014;20(46):17588-94. doi: 10.3748/wjg.v20.i46i17588.

Oguma J, Ozawa S, Omori T, Kitagawa Y, Saikawa Y, Mikami S, et al. EMR of a hyperplastic polyp arising in ectopic gastric mucosa in the cervical esophagus: case report. Gastrointest Endosc. 2005;61(2):335-8. doi: 10.1016/S0016-5107(04)02469-1.

Ciocalteu A, Popa P, Ionescu M, Gheonea D. Issues and controversies in esophageal inlet patch. World J Gastroenterol. 2019;25(30):4061-73. doi: 10.3748/wjg.v25.i30.4061.

Alagozlu H, Simsek Z, Unal S, Cindoruk M, Dumlu S, Dursun A. Is there an association between Helicobacter pylori in the inlet patch and globus sensation? World J Gastroenterol. 2010;16(1):42-7. doi: 10.3748/wjg.v16.i1.42.

Gutierrez O, Akamatsu T, Cardona H, Graham DY, El-Zimaity HMT. Helicobacter pylori and hetertopic gastric mucosa in the upper esophagus (the inlet patch). Am J Gastroenterol. 2003;98(6):1266-70. doi: 10.1111/j.1572-0241.2003.07488.x.

Tanaka M, Ushiku T, Ikemura M, Shibahara J, Seto Y, Fukayama M. Esophageal adenocarcinoma arising in cervical inlet patch with synchronous Barrett's esophagus-related dysplasia. Pathol Int. 2014;64(8):397-401. doi: 10.1111/pin.12181.

Yamada T, Tsuji A, Onoue S, Kaneko M, Tanioka F, Osawa S, et al. Acid suppressive therapy improved symptoms due to circumferential cervical inlet patch with proton pumps (H+/K+-ATPase). World J Clin Cases. 2017;5(11):403-6. doi: 10.12998/wjcc.v5.i11.403.






Research Article

How to Cite

Şengiz Erhan S, Hallac S, Ipin T, Gökden Y, Sensu S. Describing the heterotopic gastric mucosa (inlet patch) located in the esophagus with cases. J Surg Med [Internet]. 2020 Dec. 1 [cited 2024 Apr. 13];4(12):1219-22. Available from: