An inlet patch is a flat red area, often velvety in appearance, in the upper esophagus that is found incidentally on endoscopy in about one in 20 patients (5%). These lesions are usually found in the proximal 3 cm of the esophagus just below the upper esophageal sphincter. These lesions are usually found incidentally and rarely cause symptoms or develop into cancer. They are sometimes also referred to as heterotopic gastric mucosa of the upper esophagus.
The cause of inlet patches remains unclear. It may represent embryonic gastric tissue that did not convert to squamous tissue in the esophagus. Another theory believes that they are an acquired condition, similar to Barrett’s esophagus. However, the exact mechanisms for the formation of these lesions are currently unknown.
Inlet patches usually do not cause symptoms. Rare reports have shown these lesions to be associated with dysphagia, or trouble swallowing. This may be due to rings or webs that cause strictures in the region of the inlet patch. Other potential symptoms include globus (sense of fullness in the throat) and chronic cough due to reflux of GI contents into the lungs (laryngopharyngeal reflux).
The diagnosis is made by typical visual findings in the proximal esophagus on standard endoscopy. Biopsies, while not essential, can also be obtained to further confirm the diagnosis.
Treatment is usually not needed as the lesion is nearly universally benign and rarely causes symptoms. In patients with globus symptoms in whom eradication of the inlet patch is desired as a potential treatment, ablation of the inlet patch with multipolar electrocoagulation, argon plasma coagulation or radiofrequency ablation may be attempted.