A Prospective Study Comparing Patient Satisfaction and Efficacy of Two Different Methods of Ablation of Inlet Patches: Argon Plasma Coagulation Versus Radio Frequency Ablation

Inlet patches (IP) are areas of ectopic gastric mucosa in the proximal esophagus. [1-4] They also been referred to as cervical inlet patch (CIP), heterotopic gastric mucosa (HGM), heterotopic gastric mucosa of the proximal esophagus (HGMPE), and heterotopic gastric mucosa of the upper esophagus (HGMUE). While initially thought to be rare, they are in fact frequently found. Recent studies, including those specifically evaluating for their presence, have found IP in 10-14% of patients undergoing endoscopy [5-10].

While frequently identified as an incidental lesion, there is growing data that IP can cause symptoms, many of which are attributed to their ability to produce acid [11-13]. A recent meta-analysis comparing patients with IP to those without IP identified heartburn, dysphagia, throat discomfort, globus, hoarseness, and cough as being more prevalent in patients with IP [14].

Studies have shown that some throat symptoms have improved with ablation of IP performed during upper endoscopy [15-23]. The initial prospective studies involved treatment using argon plasma coagulation (APC) and showed safety, effective ablation of the IP, and improvement in symptoms [15-17]. Similar results have been shown in more recent larger retrospective studies [18,19], as well as in pediatric populations [20,21]. While most studies used APC to ablate IP, some studies also showed that radio frequency ablation (RFA) was successful in eradicating IP and improving symptoms [22,23]. However, to date, no studies have compared these two ablative methods.

In the investigators' experience, they have successfully used both methods to ablate IP. However, several patients have complained of sore throats after APC ablation, and the investigators have not experienced this after RFA. Additionally, in prior studies, patient satisfaction with these procedures has not been explored.

Aims The aims are to compare two proven methods of ablating IP-APC and RFA. The primary endpoint will be to compare patient satisfaction with the procedures (rated on a 0-10 scale), as well as complaints of pain or discomfort afterwards. Secondarily, the investigators will compare the efficacy of ablation between the two methods in terms of the number of sessions required to achieve complete IP eradication. Finally, the investigators will also assess differences in symptom improvement between the two groups.