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The Esophagogastric Junction

  • Qin Huang
Chapter

Abstract

Accurate identification of the esophagogastric junction (EGJ) is crucial for EGJ disease diagnosis, classification, and treatment in daily practice. Although a universally accepted criterion for EGJ has not been established, the most commonly used landmark for endoscopic mucosal EGJ is the proximal end of gastric longitudinal mucosal folds with a high reproducibility in different populations. As to histologic EGJ markers, the distal ends of deep esophageal glands and ducts, squamous epithelium, and multilayered epithelium are well recognized as reliable landmarks because those structures occur only in the esophagus.

Keywords

Esophagogastric junction Stomach Esophagus Multilayered epithelium Esophageal gland 

References

  1. 1.
    Jin L, Yoshida M, Kitagawa Y, et al. Subclassification of superficial cardia cancer in relation to the endoscopic esophagogastric junction. J Gastroenterol Hepatol. 2008;23(Suppl 2):S273–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Huang Q, Fan XS, Agoston AT, et al. Comparison of gastroesophageal junction carcinomas in Chinese versus American patients. Histopathology. 2011;59(2):188–97.CrossRefPubMedGoogle Scholar
  3. 3.
    Srivastava A, Odze RD, Lauwers GY, Redston M, Antonioli DA, Glickman JN. Morphologic features are useful in distinguishing Barrett esophagus from carditis with intestinal metaplasia. Am J Surg Pathol. 2007;31(11):1733–41.CrossRefPubMedGoogle Scholar
  4. 4.
    Huang Q. Definition of the esophagogastric injunction: a critical mini review. Arch Pathol Lab Med. 2011;135:384–9.PubMedGoogle Scholar
  5. 5.
    Goyal RK. Columnar cell-lined (Barrett’s) esophagus: a historical perspective. In: Spechler SJ, Goyal RK, editors. Barrett’s esophagus, pathophysiology, diagnosis and management. New York: Elsevier; 1985. p. 1–18.Google Scholar
  6. 6.
    Misumi A, Murakami A, Harada K, Baba K, Akagi M. Definition of carcinoma of the gastric cardia. Langenbecks Arch Chir. 1989;374(4):221–6.CrossRefPubMedGoogle Scholar
  7. 7.
    Huang Q, Zhang LH. The histopathologic spectrum of carcinomas involving the gastroesophageal junction in the Chinese. Int J Surg Pathol. 2007;15:38–52.CrossRefPubMedGoogle Scholar
  8. 8.
    Shamiyeh A, Szabo K, Granderath FA, Syré G, Wayand W, Zehetner J. The esophageal hiatus: what is the normal size? Surg Endosc. 2010;24(5):988–91.CrossRefPubMedGoogle Scholar
  9. 9.
    Sharma P, McQuaid K, Dent J, et al. AGA Chicago Workshop. A critical review of the diagnosis and management of Barrett’s esophagus: the AGA Chicago Workshop. Gastroenterology. 2004;127(1):310–30.CrossRefPubMedGoogle Scholar
  10. 10.
    Bombeck CT, Dillard DH, Nyhus LM. Muscular anatomy of the junction and the role of phrenoesophageal ligament. Autopsy study of sphincter mechanism. Ann Surg. 1966;164:643–54.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    McClave SA, Boyce HW Jr, Gottfried MR. Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc. 1987;33:413–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Chandrasoma PT, Lokuhetty DM, Demeester PT, et al. Definition of histopathologic changes in gastroesophageal reflux disease. Am J Surg Pathol. 2000;24:344–51.CrossRefPubMedGoogle Scholar
  13. 13.
    Ringhofer C, Lenglinger J, Izay B, et al. Histopathology of the endoscopic esophagogastric junction in patients with gastroesophageal reflux disease. Wien Klin Wochenschr. 2008;120(11–12):350–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Wieczorek TJ, Wang HH, Antonioli DA, Glickman JN, Odze RD. Pathologic features of reflux and Helicobacter pylori-associated carditis: a comparative study. Am J Surg Pathol. 2003;27(7):960–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Wallner B. Endoscopically defined gastroesophageal junction coincides with the anatomical gastroesophageal junction. Surg Endosc. 2009;23(9):2155–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Takubo K, Aida J, Sawabe M, et al. The normal anatomy around the oesophagogastric junction: a histopathologic view and its correlation with endoscopy. Best Pract Res Clin Gastroenterol. 2008;22(4):569–83.CrossRefPubMedGoogle Scholar
  17. 17.
    Takubo K, Vieth M, Aida J, et al. Differences in the definitions used for esophageal and gastric diseases in different countries. Digestion. 2009;80:248–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Ogiya K, Kawano T, Ito E, et al. Lower esophageal palisade vessels and the definition of Barrett’s esophagus. Dis Esophagus. 2008;21(7):645–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Sato T, Kato Y, Matsuura M, Gagner M. Significance of palisading longitudinal esophagus vessels: identification of the true esophagogastric junction has histopathological and oncological considerations. Dig Dis Sci. 2010;55(11):3095–101.CrossRefPubMedGoogle Scholar
  20. 20.
    DeNardi FG, Riddle RH. In: Sternberg SS, editor. Histology for pathologists. 2nd ed. New York: Raven Press; 1997. p. 461–80.Google Scholar
  21. 21.
    Huang Q, Zhang LH. Histopathological features of diseases in esophageal glands in the region of the gastroesophageal junction in Chinese patients with gastric cardiac cancer involving the esophagus. Pathol Lab Med Int. 2010;2:33–40.CrossRefGoogle Scholar
  22. 22.
    Takubo K, Arai T, Sawabe M, et al. Structures of the normal esophagus and Barrett’s esophagus. Esophagus. 2003;1:37–47.CrossRefGoogle Scholar
  23. 23.
    Nakanishi Y, Saka M, Eguchi T, Sekine S, Taniguchi H, Shimoda T. Distribution and significance of the oesophageal and gastric cardiac mucosae: a study of 131 operation specimens. Histopathology. 2007;51(4):515–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Law S, Lam KY, Chu KM, Wong J. Specialized intestinal metaplasia and carditis at the gastroesophageal junction in Chinese patients undergoing endoscopy Specialized Intestinal Metaplasia. Am J Gastroenterol. 2002;97:1924–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Fan XS, Feng AN, Lauwers GY, Huang Q. Esophageal columnar metaplasia is common in the distal esophagus of Chinese patients. Gastroenterology. 2010;138(5 Suppl 1):S-758.Google Scholar
  26. 26.
    Takubo K, Sasajima K, Yamashita K, Tanaka Y, Fujita K. Double muscularis mucosae in Barrett’s esophagus. Hum Pathol. 1991;22(11):1158–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Takubo K, Vieth M, Aryal G, et al. Islands of squamous epithelium and their surrounding mucosa in columnar-lined esophagus: a pathognomonic feature of Barrett’s esophagus? Hum Pathol. 2005;36(3):269–74.CrossRefPubMedGoogle Scholar
  28. 28.
    Owen DA. Stomach (chapter 20). In: Sternberg SS, editor. Histology for pathologists. 2nd ed. New York: Raven Press; 1997. p. 481–93.Google Scholar
  29. 29.
    Chandrasoma P, Makarewicz K, Wickramasinghe K, Ma Y, Demeester T. A proposal for a new validated histological definition of the gastroesophageal junction. Hum Pathol. 2006;37(1):40–7.CrossRefPubMedGoogle Scholar
  30. 30.
    Glickman JN, Chen YY, Wang HH, Antonioli DA, Odze RD. Phenotypic characteristics of a distinctive multilayered epithelium suggests that it is a precursor in the development of Barrett’s esophagus. Am J Surg Pathol. 2001;25(5):569–78.CrossRefPubMedGoogle Scholar
  31. 31.
    Fitzgerald RC, di Pietro M, Ragunath K, et al. British Society of Gastroenterology. British Society of Gastroenterology guidelines on the diagnosis and management of Barrett’s oesophagus. Gut. 2014;63:7–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Wang X, Ouyang H, Yamamoto Y, et al. Residual embryonic cells as precursors of a Barrett’s-like metaplasia. Cell. 2011;145(7):1023–35.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Qin Huang
    • 1
    • 2
  1. 1.Pathology and Laboratory MedicineVeterans Affairs Boston Healthcare SystemWest RoxburyUSA
  2. 2.Harvard Medical School and Brigham and Women’s HospitalBostonUSA

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