[Clinical anatomy of the esophagogastric junction]

The esophagogastric junction is a controversial anatomical area, due to its sphincteric mechanism which does not show an obvious anatomical basis. The aim of this study is to investigate the anatomical components that endoscopically indicate the mucosal esophagogastric junction in hiatal hernia patients.

The esophagogastric junction was investigated in 27 hiatal hernia patients undergoing surgery. Hiatal hernia is an extension of the stomach situated between the esophagogastric junction and the diaphragmatic indentation. The following types of hiatal hernia were found: sliding hiatal hernia (type I) in 4 patients (14.81%), rolling hiatal hernia (type II) in 2 (7.4%), mixed hiatal hernia (type III) in 12 (44.44%), type IV hiatal hernia in 4 (14.81%) and recurrent hiatal hernia in 5 (18.51%). Of the 27 hiatal hernia patients, 8 (29.6%) were operated using classical procedures: laparotomy--6 (75%) and laparoscopic surgery--2 (25%).

The angle of His cannot be used for marking the mucosal esophagogastric junction due to the severe damage of the lower esophageal sphincter in hiatal hernia patients. The squamocolumnar junction is displaced in hiatal hernia patients and was not an option for the study group. The distal end of the esophageal longitudinal palisading vessels needs medication (proton pump inhibitors that reduce the gastric acid production), in order to enhance the visibility of these vessels. The proximal end of gastric longitudinal mucosal folds proved to be the most reliable site to identify endoscopically the mucosal esophagogastric junction.

The anatomical structure of the esophagogastric junction differs in hiatal hernia patients and these peculiarities are very important in surgery.