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Chronic globus sensation due to inlet patch – new endoscopic treatment

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Case study

A 52-year-old woman, AL, was

referred by her GP to ENT surgeons

with a history of sore throat and

globus sensation for over a year.

She underwent full ENT diagnostic

workup and no cause was

found, though note was made

of laryngeal oedema consistent

with acid irritation of the larynx.

Gastroenterology opinion to assess

for Gastro-Oesophageal Reflux

Disease (GORD) was advised.

She subsequently underwent a

gastroscopy which revealed a

large inlet patch, the size of a

50p coin, at the very top of the

oesophagus and was referred to

Dr Dunn for further evaluation.

The inlet patch was characterised

using Narrow Band Imaging, an

optical enhancement technique.

The lesion was then treated with

RFA using a Through-The-Scope

(TTS) device which causes minimal

irritation during the procedure.

This was undertaken as a day

case under conscious sedation.

Inlet patch proximal oesophagus x2

BarrX TTS RFA device

Biography

Dr Jason Dunn is a Consultant

Gastroenterologist at Guy’s and

St Thomas’ NHS Foundation Trust

Hospital. His special interest in

Barrett’s Oesophagus followed

a CRUK clinical fellowship at

UCL, where he studied the use of

optical diagnostics and minimally

invasive endoscopic therapies. His

work on the treatment of Barrett’s

Oesophagus with RFA, and the use

of biomarkers to predict cancer

progression, has won prizes and

been published in high impact

factor journals.

Dr Dunn is proficient in EMR

and RFA, and teaches these

techniques internationally. He is

the Early Diagnosis Lead for the

London Cancer Alliance (LCA)

and has written guidelines for

the management of Barrett’s

Oesophagus for the LCA. He

currently holds Honorary Senior

Lecturer posts at King’s College

London and Oslo University in the

Institute of Medical Informatics,

and continues to be involved in

research into novel endoscopic

treatment of GI conditions.

After two months, a further session

of treatment was undertaken, but

already AL had noted a significant

improvement in symptoms. At the

second treatment, a tiny focus of inlet

patch remained that was treated, and

subsequently AL is symptom-free. Six

months after referral, the patient has

no residual visible inlet patch.

Other images

Pre and post RFA i) Inlet patch at 8

o’clock position ii) Immediately after

first ablation iii) Complete resolution

three months after first ablation.

For more information on inlet patch and radiofrequency ablation, or to make an appointment,

visit

www.londondigestion.co.uk ,

or contact Nicole Merrall at

[email protected] ,

telephone

020 7403 3814

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