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Endoscopically defined gastroesophageal junction coincides with the anatomical gastroesophageal junction

Abstract

Introduction

The gastroesophageal junction is a complex anatomic area. Precise endoscopic assessment of the gastroesophageal junction is of utter importance, especially regarding Barrett’s esophagus and neoplasms of the gastroesophageal junction. There has been a lack of a validated definition of the endoscopic gastroesophageal junction.

Methods

Seven patients scheduled for resection of the gastroesophageal junction were included. Before surgery, gastroscopy was performed and the gastroesophageal junction was assessed. If there was disparity between the endoscopic gastroesophageal junction and the Z-line, the gastroesophageal junction was marked with India ink tattooing. Postoperatively the resection specimens were evaluated and the anatomical gastroesophageal junction was compared with the endoscopic.

Results

In all seven patients the measured difference between the gastroesophageal junction and the endoscopic junction was <5 mm.

Conclusions

The upper margin of the longitudinal folds of the stomach can be used as an appropriate endoscopic definition of the gastroesophageal junction.

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References

  1. 1.

    Boyce HW (2000) Endoscopic definitions of esophagogastric junction regional anatomy. Gastrointest Endosc 51:586–592

  2. 2.

    DeNardi FG, Riddell RH (1991) The normal esophagus. Am J Surg Pathol 15:296–309

  3. 3.

    Kahrilas PJ (1997) Anatomy and physiology of the gastroesophageal junction. Gastroenterol Clin North Am 26:467–486

  4. 4.

    Friedland GW (1978) Historical review of the changing concept of lower esophageal anatomy: 430 B.C.–1977. Am J Roentgenol 131:373–388

  5. 5.

    Hayward J (1961) The lower end of the oesophagus. Thorax 16:36–41

  6. 6.

    Paris workshop on columnar metaplasia in the esophagus and the esophagogastric junction, Paris, France, December 11–12, 2004. Endoscopy (2005) 37:879–920

  7. 7.

    Armstrong D (2004) Review article: towards consistency in the endoscopic diagnosis of Barrett’s oesophagus and columnar metaplasia. Aliment Pharmacol Ther 20(Suppl 5):40–47; discussion 61–62

  8. 8.

    McClave SA, Boyce HWJ, Gottfried MR (1987) Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc 33:413–416

  9. 9.

    Sharma P, McQuaid K, Dent J et al (2004) A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology 127:310–330

  10. 10.

    Shaffer RT, Francis JM, Carrougher JG et al (1998) India ink tattooing in the esophagus. Gastrointest Endosc 47:257–260

  11. 11.

    Lagergren J, Bergstrom R, Lindgren A, Nyren O (1999) Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831

  12. 12.

    Sharma P, Weston AP, Morales T, Topalovski M, Mayo MS, Sampliner RE (2000) Relative risk of dysplasia for patients with intestinal metaplasia in the distal oesophagus and in the gastric cardia. Gut 46:9–13

  13. 13.

    Armstrong D (2003) Towards consistency in the endoscopic diagnosis of Barrett’s esophagus/coulmnar metaplasia. Critical Evidence in 2003: Reflux, Acid and Barrett’s, AstraZeneca International Symposium. 2003; Marbella, Spain

  14. 14.

    Wallner B, Sylvan A, Stenling R, Janunger KG (2000) The esophageal Z-line appearance correlates to the prevalence of intestinal metaplasia. Scand J Gastroenterol 35:17–22

  15. 15.

    Wallner B, Sylvan A, Janunger KG (2002) Endoscopic assessment of the “Z-line” (squamocolumnar junction) appearance: reproducibility of the ZAP classification among endoscopists. Gastrointest Endosc 55:65–69

  16. 16.

    Guda NM, Partington S, Vakil N (2004) Inter- and intra-observer variability in the measurement of length at endoscopy: implications for the measurement of Barrett’s esophagus. Gastrointest Endosc 59:655–658

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Correspondence to Bengt Wallner.

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Wallner, B. Endoscopically defined gastroesophageal junction coincides with the anatomical gastroesophageal junction. Surg Endosc 23, 2155–2158 (2009). https://doi.org/10.1007/s00464-008-0238-9

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Keywords

  • Anatomy
  • Barrett’s esophagus
  • Endoscopy
  • Esophagus
  • Gastroesophageal junction