Argon Plasma Ablation of Gastric Inlet Patches in the Cervical Esophagus may Alleviate Globus Sensation: A Pilot Trial.
BACKGROUND AND STUDY AIMS: Globus sensation and/or sore throat have been associated with both gastroesophageal reflux disease and the presence of a gastric inlet patch. There have been no reports, however, on whether ablation of heterotopic mucosa in the cervical esophagus leads to improvement of chronic globus sensation. PATIENTS AND METHODS: Ten patients with a histologically proved gastric inlet patch who complained of chronic globus sensation and/or sore throat were included in this prospective pilot study. After a thorough assessment, including videofluoroscopy, laryngoscopy, manometry, and 24-hour two-channel pH monitoring, patients underwent argon plasma coagulation (APC) to ablate the heterotopic mucosa. A questionnaire with a visual analog scale ranging from 0 to 10 was used for assessment of globus sensation, sore throat, and other typical or atypical reflux symptoms. Follow-up examinations (including symptom assessment) were performed 4 weeks and 8 weeks after APC therapy. RESULTS: Ablation of thegastric inlet patch resulted in a significant reduction of median symptom scores for globus sensation (from 2.7 to 0) and sore throat (from 2.8 to 0) 8 weeks after therapy ( P< 0.05), but there was no improvement in other reflux-related symptoms. Acid reflux in the distal and proximal esophagus, determined by two-channel pH monitoring, did not change after therapy. CONCLUSIONS: Our preliminary data suggest that ablation of gastric inlet patches by APC can alleviate chronic globus sensation or sore throat. Acid reflux or its treatment is unlikely to influence these results. A randomized and blinded study is warranted.