A proposal for a new validated histological definition of the gastroesophageal junction

Videoendoscopy and histopathology of the esophagogastric junction in patients with gastroesophageal reflux disease

“…Our current understanding is that CLE results from gastroesophageal refluxinduced damage and columnar metaplasia of squamous epithelium [2][3][4]. Depending on cell types present within the subfoveolar region of the glands, the Paull-Chandrasoma classification of CLE lists the following nondysplastic mucosal types [3,[5][6][7]: cardiac mucosa (mucus cells only) and oxyntocardiac mucosa (parietal and mucus cells). Multilayered epithelium describes cardiac mucosa covering several layers of basal cells of squamous epithelium, presumably indicating the 'birth' of CLE out of squamous epithelium [3,8].…”

“…Difficulties in the diagnosis of CLE arise from different endoscopic, histologic and anatomic definitions of the esophagogastric junction [1,3,7,8,[16][17][18][19][20][21]. During endoscopy the esophagus is considered to end at the level of the start of the gastric folds [16,18,19].…”

“…Any visible segment of gastric-type mucosa interposed between squamous mucosa and gastric-type mucosa is CLE and is recommended for biopsy sampling to exclude the presence of IM (Barrett esophagus) [16,18,19]. Histology categorizes the above types of CLE [1,3,5,[7][8], but it is not clear if these gastric-type epithelia belong to the stomach or to the esophagus (gastric vs. esophageal disease?). The answer is obtained from anatomy [1,3,7,20]: normally the esophagus contains submucosal glands and is lined by squamous epithelium [7,20], whereas the stomach is devoid of submucosal glands and is lined by oxyntic mucosa in its proximal part and covered by antral mucosa distally [1,3,7,20].…”

“…Histology categorizes the above types of CLE [1,3,5,[7][8], but it is not clear if these gastric-type epithelia belong to the stomach or to the esophagus (gastric vs. esophageal disease?). The answer is obtained from anatomy [1,3,7,20]: normally the esophagus contains submucosal glands and is lined by squamous epithelium [7,20], whereas the stomach is devoid of submucosal glands and is lined by oxyntic mucosa in its proximal part and covered by antral mucosa distally [1,3,7,20]. By combining the anatomy and histopathology, Chandrasoma et al [1,7] recently demonstrated that CLE is always underlined by submucosal glands and colocalizes with submucosal gland ducts.…”

Frecuencia relativa de carcinoma escamoso y adenocarcinoma esofágicos en una serie de biopsias endoscópicas realizadas en Rosario, Argentina

“…En esta serie -que sólo incluye casos remitidos como biopsias esofágicas por endoscopistas-no realizamos esa diferencia, incluso si algunos de los casos podían considerarse como adenocarcinoma cardial, teniendo en cuenta que muchos autores atribuyen una patogenia similar a ambas lesiones y las consideran en conjunto (19).…”