Radiofrequency Ablation (RFA) as an Effective Instrument in Therapy of Recurrent, Symptomatic Heterotopic Gastric Mucosa (HGM Type II) in the Cervical Esophagus

Clinical Image

Austin J Otolaryngol. 2015;2(6): 1051.

Radiofrequency Ablation (RFA) as an Effective Instrument in Therapy of Recurrent, Symptomatic Heterotopic Gastric Mucosa (HGM Type II) in the Cervical Esophagus

Richter-Schrag HJ*, Thimme R and Walker C

Department of Medicine II, University of Freiburg, Germany

*Corresponding author: Hans-Juergen Richter- Schrag, Department of Medicine II, Interdisciplinary Gastrointestinal Endoscopy, University of Freiburg, Sir- A-Krebs Street, Freiburg D-79106, Germany

Received: July 18, 2015; Accepted: August 26, 2015; Published: August 28, 2015

Clinical Image

Heterotopic gastric mucosa in the cervical esophagus remains asymptomatic (HGM I) in most cases, and varies from microscopic to macroscopically visible lesions. Prevalence ranges from 1-13.8 % [1]. Laryngopharyngeal reflux symptoms like dysphagia or odynophagia (HGM II) or severe complications, like fistula, strictures or malignant transformation (HGM III,-V) seldom occur [2]. Available studies indicate argon plasma coagulation (APC) being an effective treatment [3].

In July 2014 a 30-year old man underwent esophagogastroduodenoscopy (EGD) due to odynophagia persisting despite taking proton pump inhibitors. Ear-nosethroat examination showed no pathologies. Impedanz (Impedanz, Tecnomatix, Germany), showed no gastroesophageal reflux whereas laryngopharyngeal reflux (LPR) was shown (RestechTM, Promedics, Germany). At a threshold of pH <6,40 pharyngeal reflux events were seen in 24h. Additionally EGD with narrow-band imaging system (NBI) and histological examination revealed a 0.25 mm large HGM Type II of the oxyntic cell type (Figure 1, A1). Repeated APC-therapy achieved a significant improvement of symptoms and pharyngeal acid exposure (Figure 1, B1/2). However symptoms and measured pharyngeal acid reappeared. Successive exploration showed multiple micro-HGMs again, partially overlaid with squamous epithelium (Figure 2, A1). Hence, circular treatment with radiofrequency ablation (Barrx™ 90, Covidien, Germany) was performed (Figure 2, B1). Until now the patient is free from symptoms and LPR (Figure2, B2).

Citation: Richter-Schrag HJ, Thimme R and Walker C. Radiofrequency Ablation (RFA) as an Effective Instrument in Therapy of Recurrent, Symptomatic Heterotopic Gastric Mucosa (HGM Type II) in the Cervical Esophagus. Austin J Otolaryngol. 2015;2(6): 1051. ISSN :2473-0645