Definition of Real Esophago-Gastric Junction

Takahiro Sato^1,2* and Yo Kato^3,4

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
Tel: +81-4-2962-1251
Fax: +81-4-2962-0865
E-mail: takahiro-aogp@biglobe.jp

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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Abstract

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.

Keywords

Palisading longitudinal esophagus vessels; Esophagogastric junction; Squamo-columnar Junction; Barrett’s epithelium; Gastric cardia cancer

Abbreviations

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 [1]. Infection by Helicobacter pylori (H. pylori) and gastric atrophy have also been associated with the development of gastric cancer [2]. 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 [9]. 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 [10], 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].

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