Diagnosis

Endoscopic diagnostic criteria

► Visible only in retroflexion (Fig. 3.12)

► Normal configuration of the cardia

► Next to the normal cardia is a second lumen, with mu-cosal folds radiating into it

► Caution: Avoid entering the hernia with the retroflexed scope.

Differential diagnosis

► The typical appearance is unmistakable.

Checklist for endoscopic evaluation

► Inspect the hernia in retroflexion.

► Check for associated axial sliding hernia (common).

► Complications?

► Ulceration, necrosis, and incarceration are rarely detectable by endoscopy.

Additional Study ► Radiographic contrast examination

Comments

As there is a potential for incarceration, surgical correction is recommended even for asymptomatic cases (gastropexy, fundo-plication for combined hernias).

Fig.3.13Typesofhernia

Cardia

Esophagus

Cardia

Cardia

Fig.3.13Typesofhernia

Esophagus

Cardia

Cardia

Cardia

Paraesophageal Hernia Axial

Diaphragm a Axial hernia. The cardia is abovethe hiatus b Paraesophageal hernia. The cardia is at the level of the hiatus c Mixed hernia

Diaphragm a Axial hernia. The cardia is abovethe hiatus b Paraesophageal hernia. The cardia is at the level of the hiatus c Mixed hernia

Fig. 3.12 Paraesophageal hernias a Retroflexed view demonstrates the hernia at the 2-o'clock position

c Paraesophageal hernia at the 12-o'clock position b Close-up view c Paraesophageal hernia at the 12-o'clock position

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