Kyoto international consensus report on anatomy, pathophysiology and clinical significance of the gastro-oesophageal junction

Abstract

ObjectiveAn international meeting was organised to develop consensus on (1) the landmarks to define the gastro-oesophageal junction (GOJ), (2) the occurrence and pathophysiological significance of the cardiac gland, (3) the definition of the gastro-oesophageal junctional zone (GOJZ) and (4) the causes of inflammation, metaplasia and neoplasia occurring in the GOJZ.DesignClinical questions relevant to the afore-mentioned major issues were drafted for which expert panels formulated relevant statements and textural explanations.A Delphi method using an anonymous system was employed to develop the consensus, the level of which was predefined as ≥80% of agreement. Two rounds of voting and amendments were completed before the meeting at which clinical questions and consensus were finalised.ResultsTwenty eight clinical questions and statements were finalised after extensive amendments. Critical consensus was achieved: (1) definition for the GOJ, (2) definition of the GOJZ spanning 1 cm proximal and distal to the GOJ as defined by the end of palisade vessels was accepted based on the anatomical distribution of cardiac type gland, (3) chemical and bacterial (Helicobacter pylori) factors as the primary causes of inflammation, metaplasia and neoplasia occurring in the GOJZ, (4) a new definition of Barrett’s oesophagus (BO).ConclusionsThis international consensus on the new definitions of BO, GOJ and the GOJZ will be instrumental in future studies aiming to resolve many issues on this important anatomic area and hopefully will lead to better classification and management of the diseases surrounding the GOJ.

Management ofHelicobacter pyloriinfection: the Maastricht VI/Florence consensus report

“…H. pylori is the key risk factor also in PGC 308. This fits in the new concept of GOJZ cancer which addresses the adenocarcinoma occurring 1 cm proximal to and 1 cm distal to GOJ which clarifies the pathogenetic mechanisms for cancer occurring at the GOJZ 311…”

“…308 This fits in the new concept of GOJZ cancer which addresses the adenocarcinoma occurring 1 cm proximal to and 1 cm distal to GOJ which clarifies the pathogenetic mechanisms for cancer occurring at the GOJZ. 311 A number of studies have strongly indicated that there are at least two major aetiological factors for GOJ adenocarcinoma, one from inflammation caused by gastroduodenal reflux and the other from inflammation of junctional gastric mucosa including cardiac-type mucosa mainly by H. pylori infection. 307 312-314 Statement 3: The influence of environmental factors is subordinate to the effect of H. pylori infection.…”

Minimally invasive endoscopic therapies for gastro-oesophageal reflux disease

“…The gastro-oesophageal junction is a complex zone that is still not anatomically or physiologically understood in its entirety. 67 Currently, ARETs cannot be recommended over first-line ARS for many patients but do represent an alternative option for very high-risk surgical candidates with smaller hiatus hernias and milder forms of GORD. To ensure successful outcomes patient selection is key and a considered patient selection process is warranted.…”

“…Over the last two decades a number of devices and techniques have been developed and evaluated with many being withdrawn or not reaching mainstream popularity. The gastro-oesophageal junction is a complex zone that is still not anatomically or physiologically understood in its entirety 67…”

One cm of Columnar Epithelium: Does It Matter?

“…23 Moreover, pseudo-goblet cells defined as mucinous, gastric foveolar-type columnar cells that have distended cytoplasmicvacuoles can easily be misinterpreted as goblet cells and therefore a biopsy misdiagnosed as IM. 21…”