Definition of Real Esophago-Gastric Junction
Takahiro Sato1,2* and Yo Kato3,4
1Gastroenterological Surgery, Comprehensive Cancer Center, Saitama Medical Universiy International Medical Center 1397-1 Yamane, Hidaka, 350-1298, Japan
2Gastroenterological Surgery, Harada Hospital, 1-13-3 Toyooka, Iruma, 358-0003, Japan
3Department of Pathology, Nikko Medical Center, Dokkyo Medical University, 632 Takatoku, Nikko, Tochigi, 321-2593, Japan
4Department of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, 3-10-6, Ariake, Koto-ku, Tokyo 135-8550, Japan
- *Corresponding Author:
- Takahiro Sato
Gastroenterological Surgery, Harada Hospital
1-13-3 Toyooka, Iruma, 358-0003, Japan
E-mail: [email protected]
Received date: July 08, 2013; Accepted date: August 08, 2013; Published date: August 11, 2013
Citation: Sato T, Kato Y (2013) Definition of Real Esophago-Gastric Junction. J Gastroint Dig Syst 3:130. doi:10.4172/2161-069X.1000130
Copyright: © 2013 Sato T, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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An increase in the incidence of esophageal adenocarcinoma and gastric cardia cancer has been reported in Western countries. However, the lack of universally accepted criteria for the esophago-gastric junction (EGJ) continues to result clinically in confusion in diagnosis of gastric cardia cancer, esophageal adenocarcinoma and Barrett’s esophagus (BE), not only in Japan but also in Western countries. The definition of real EGJ would minimize bias and error and lead to etiologic hypothesis.
Palisading longitudinal esophagus vessels; Esophagogastric junction; Squamo-columnar Junction; Barrett’s epithelium; Gastric cardia cancer
EGJ: Esophago-Gastric Junction; SCJ: Squamo-Columnar Junction; PLEV: Palisading Longitudinal Esophagus Vessel; H. pylori: Helicobacter pylori; BE: Barrett’s Esophagus; SSBE: Short Segment Barrett’s Esophagus; GERD: Gastro-Esophageal Reflux Disease
The incidence rate of gastric cancer in Japan is one of the highest in developed countries . Infection by Helicobacter pylori (H. pylori) and gastric atrophy have also been associated with the development of gastric cancer . On the other hand, association of H. pylori infection with the risk of stomach cancer is restricted to the noncardia region, while the cardia region shares the same risk factors as the distal part of esophagus, for which an inverse association of H. pylori infection with esophageal adenocarcinoma has been reported [3- 6]. An increase in the incidence of esophageal adenocarcinoma and gastric cardia cancer has been reported in Western countries [7,8]. On the other hand, in Japan, where both Barrett’s esophagus (BE) and esophageal adenocarcinoma are far more uncommon than in Western countries, the increase seems to be slight as is that of BE . However, the lack of universally accepted criteria for the esophagogastric junction (EGJ) continues to result clinically in confusion in diagnosis of Barrett’s esophagus, not only in Japan but also in Western countries. Therefore, it is difficult to know true incidences of gastric cardia cancer, esophageal adenocarcinoma and BE, particularly short segment Barrett’s esophagus (SSBE). In endoscopy, as a marker of the EGJ, more attention has been paid to the proximal margin of gastric folds in Western countries , whereas in Japan, use of the most distal ends of the palisading longitudinal esophagus vessels (PLEVs) is more prevalent [11-13].
In authentic textbooks, the positions of squamo-columnar junction (SCJ) and EGJ is coincident in the older textbooks [14-17]. In contrast, SCJ in normal is shifted proximal to the EGJ in the recent textbooks [18,19].
Sharma, et al. emphasized the definition of real EGJ and the association of the length of Barrett’s esophagus with cancer risk [20,21].
To this end, further investigation evaluating the real esophagogastric junction correctly should be needed. In the same way, the improved quality of data collected by cancer surveillance systems in various countries would minimize bias and error, and thus lead to etiologic hypothesis [22,23].
- IARC. In: Parkin DM, Whelan SL, Ferlay J , Teppo L, Thomas DB editors (2002) Cancer incidence in five continents, vol VI-VIII. Lyon: IARC Scientific Publication France.
- Suzuki H, Iwasaki E, Hibi T (2009) Helicobacter pylori and gastric cancer. Gastric Cancer 12: 79-87.
- Lochhead P, El-Omar EM (2008) Gastric cancer. Br Med Bull 85: 87-100.
- Islami F, Kamangar F (2008) Helicobacter pylori and esophageal cancer risk: a meta-analysis. Cancer Prev Res (Phila) 1: 329-338.
- Helicobacter and Cancer Collaborative Group (2001) Gastric cancer and Helicobacter pylori: a combined analysis of 12 case control studies nested within prospective cohorts. Gut 49: 347-353.
- Souza RF, Spechler SJ (2005) Concepts in the prevention of adenocarcinoma of the distal esophagus and proximal stomach. CA Cancer J Clin 55: 334-351.
- Watson A, Sampliner RE, Appleman HD (2003) The definition of "Barrett's esophagus." In: Giuli R, Siewert JR, Countrier D, Scarpignato C, editors. Barrett's esophagus. Montrouge: John Libbey Eurotext: 1-4.
- Blot WJ, Devesa SS, Kneller RW, Fraumeni JF Jr (1991) Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265: 1287-1289.
- Abe Y, Ohara S, Koike T, Sekine H, Iijima K, et al. (2004) The prevalence of Helicobacter pylori infection and the status of gastric acid secretion in patients with Barrett's esophagus in Japan. Am J Gastroenterol 99: 1213-1221.
- McClave SA, Boyce HW Jr, Gottfried MR (1987) Early diagnosis of columnar-lined esophagus: a new endoscopic diagnostic criterion. Gastrointest Endosc 33: 413-416.
- Hoshihara Y, Kogure T. (2006) What are longitudinal vessels? Endoscopic observation and clinical significance of longitudinal vessels in the lower esophagus. Esophagus 3: 145-150.
- Sato T, Kato Y (2008) Palisading longitudinal esophagus vessels at esophago-gastric junction. Hepatogastroenterology 55: 305-307.
- Sato T, Kato Y, Matsuura M, Gagner M (2010) Significance of palisading longitudinal esophagus vessels: identification of the true esophagogastric junction has histopathological and oncological considerations. Dig Dis Sci 55: 3095-3101.
- Fenoglio-Preiser CM, Noffsinger AE, Stemmermann GN (1999) The normal anatomy of the esophagus. Gastrointestinal Pathology 2nd edn. New York: Lippincott Raven.
- Kopsch FR (1936) Rauer-Kopsch Lehrbuch und Atras Der Anatomie des Menschen (14te Auflage). Georg Thieme Verlag, Leipzig.
- Spanner R (1954) Spaltheholz Handatlas und Lehrbuch der Anatomie des Menschen (15te Auflage). Scheltema & Holkema NV, Amsterdam.
- Sobotta J (1953) Atlas der deskriptiven Anatomie des Menschen: T. Regiones corporis, systema skeleti, systema musculorum. Urban & Schwarzenberg.
- WHO (Hamilton SR, Aaltonen LA) (2000) Pathology & Genetics, Tumours of the Digestive System. IARC Press, Lyon.
- Netter FH (1997) Atras of Human Anatomy. 2nd edition, Hoechteter Printing Company, USA.
- Sharma P, Morales TG, Sampliner RE (1998) Short segment Barrett's esophagus--the need for standardization of the definition and of endoscopic criteria. Am J Gastroenterol 93: 1033-1036.
- Sharma P, McCallum RW, Lundell L (2000) The geoprevalence of Barrett's esophagus. Presented at the Sixth OESO World Congress, Paris, France.
- Sato T, Miwa K, Sahara H, Segawa M, Hattori T (2002) The sequential model of Barrett's esophagus and adenocarcinoma induced by duodeno-esophageal reflux without exogenous carcinogens. Anticancer Res 22: 39-44.
- Miwa K, Sahara H, Segawa M, Kinami S, Sato T, et al. (1996) Reflux of duodenal or gastro-duodenal contents induces esophageal carcinoma in rats. Int J Cancer 67: 269-274.