Elsevier

Gastrointestinal Endoscopy

Volume 33, Issue 6, December 1987, Pages 413-416
Gastrointestinal Endoscopy

Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion

https://doi.org/10.1016/S0016-5107(87)71676-9Get rights and content

The relationship between the proximal margins of the gastric mticosal folds and the squamocolumnar mucosal junction (SCMJ) in normal subjects and in patients with columnar-lined esophagus (CLE) was studied. Results indicate that in the normal esophagus, the SCMJ is located within 2 cm of the proximal margin of the gastric folds. The proximal margin of the gastric folds in a hiatal hernia pouch provide a fixed, reproducible, anatomic landmark at endoscopy, which designates the junction of the muscular wall of the esophagus and stomach and permits one to predict the expected normal location of the SCMJ. The diagnosis of CLE should be considered at endoscopy when either the SCMJ is located or columnar epithelium is obtained by biopsy at a site greater than 2 cm above the proximal margin of the gastric folds located within a hiatal hernia pouch. This study provides an endoscopic criterion to permit a more accurate diagnosis of CLE in its earliest stages and may permit a better assessment of its prevalence.

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    During endoscopy, three important landmarks need to be recognized: 1) the GOJ, 2) the diaphragmatic pinch and 3) the squamo-columnar junction (SCJ). The GOJ signals the end of the oesophagus and the start of the stomach and is best identified as the most proximal margin of the gastric folds.33 The diaphragmatic pinch is the point at which the diaphragmatic crura constricts or ‘pinches’ the oesophagus and is an important landmark to denote the presence of a hiatal hernia.

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The data for this study were collected at the University of South Florida College of Medicine in Tampa, Florida, between February 1984 and June 1985.

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