S1027 To Treat or Not to Treat Gastric Inlet Patches? Efficacy and Safety of Argon Plasma Coagulation and Radiofrequency Ablation

Introduction: Gastric inlet patches (GIPs) are heterotopic areas of gastric mucosa typically located in the upper esophagus, often associated with hoarseness, globus sensation, heartburn, and chronic cough. While treatment modalities such as argon plasma coagulation (APC) and radiofrequency ablation (RFA) have demonstrated symptomatic improvement in recent studies, skepticism remains about the overall success of these interventions. The lack of standardized guidelines has perpetuated the notion that treatment for GIPs may be inconsistent. This study aims to challenge this perspective and provide evidence that treatment, regardless of the modality, is effective in improving symptoms. Methods: Two authors independently searched MEDLINE (PubMed) and Embase for all relevant articles. Thereafter, the retrieved articles were screened by their titles and abstracts, and potentially relevant articles underwent full-text screening. A third author resolved any disagreements. We used R version 4.4.1 to calculate pooled proportions with 95% confidence intervals (95% CIs) for dichotomous outcomes and mean differences (MDs) between pre-and post-intervention values with 95% CIs for continuous outcomes in a random effects model. Freeman-Tukey double-arcsine transformed data was used for proportions, and the restricted maximum-likelihood estimator was used to calculate variance. Results: Nine studies were included in this systematic review and meta-analysis: Five used APC and 4 used RFA. Clinical success rates were 68% (95% CI 58-78%) for APC and 75% (95% CI 55-91%) for RFA. APC reduced symptom scores for hoarseness by 1.37 points (95% CI 0.77-1.97; P < 0.01), globus sensation by 3.67 points (95% CI 0.44-6.90; P = 0.03), heartburn by 0.93 points (95% CI 0.23-1.62; P < 0.01), and cough by 0.81 points (95% CI 0.23-1.40; P < 0.01). RFA reduced hoarseness by 3.83 points (95% CI 0.55-7.11; P = 0.02) and globus sensation by 5.53 points (95% CI 3.94-7.12; P < 0.01) but did not improve heartburn. Mild to moderate adverse events occurred in 14% of APC cases, including transient dysphagia and pain. Recurrence rates were 37% for APC and 15% for RFA. Conclusion: Our findings challenge the current lack of consensus and supports the effectiveness of both modalities in treating symptomatic GIPs, confirming that endoscopic treatment for GIPs is not only viable but also effective. Additional large-scale head-to-head trials are needed to continue to support efficacy of both treatment modalities and standardize recommendations.