Diagnosis

Endoscopic diagnostic criteria

- Gastric interior is already visible several centimeters above the cardia

► Retroflexed view

- Absence of cardial closure around the endoscope in retroflexion (Fig. 3.10)

- Retroflexed view into the esophagus

► Caution: Do not pull the retroflexed tip into the esophagus.

Differential diagnosis

► Normal finding

► Endoscopic artifact

► Examiner subjectivity

Checklist for endoscopic evaluation

► Closure of the cardia in forward and retroflexed views

► Axial sliding hernia?

► Signs of reflux esophagitis?

► Gastroesophageal prolapse?

Additional Study

► Esophageal manometry

Comments

Since the endoscopic interpretation is highly subjective, you should be careful when making a diagnosis of cardial incompetence.

Fig. 3.9 Gastroesophageal junction a-c Observation of the gastroesophageal junction for approximately 30 seconds. Notice the absence of sphincter closure

Fig. 3.9 Gastroesophageal junction a-c Observation of the gastroesophageal junction for approximately 30 seconds. Notice the absence of sphincter closure

Fig. 3.10 Cardial incompetence. Retro-flexed view. Note the failure of the cardia to close snugly around the endoscope (cf. p. 47)

CT TO

TO U

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