{"title":"The Esophagogastric Junction Integrity","authors":"Salih Samo","doi":"10.1177/26345161231170426","DOIUrl":null,"url":null,"abstract":"To the editor, I read with great interest the article “The American Foregut Society white paper on the endoscopic classification of esophagogastric junction integrity”1 published in the journal. The newly proposed American Foregut Society (AFS) classification to grade the antireflux barrier (ARB) integrity provides more comprehensive evaluation that are relevant to the practicing clinicians in day-to-day practice. The authors appropriately call for future validation of this novel classification and its correlation with the presence and severity of gastroesophageal reflux disease, and additionally to extend the classification to assess the ARB integrity in individuals with prior antireflux interventions,1 whether surgical or endoscopic. However, the future directions fall short of addressing 2 important variables that may affect the assessment of ARB integrity by applying the AFS classification. First, the classification does not take into consideration the anesthesia effect on the ARB. The hiatal aperture tends to be larger under general anesthesia with use of paralytics as compared to conscious sedation without the use of paralytics. Second, the novel AFS classification does not take obesity into consideration either. It is common to see a large fat pad in the diaphragmatic hiatus during laparoscopy, which may prevent accurate appreciation of a hidden hiatal hernia, whether endoscopically or laparoscopically. Therefore, caution needs to be taken when evaluating for hiatal hernia in obese patients, and other modalities, such as upper gastrointestinal contrast study, should be used to assess for presence of hiatal hernias.2 Addressing these 2 important issues is of paramount importance in future studies. Declaration of Conflicting Interests","PeriodicalId":73049,"journal":{"name":"Foregut (Thousand Oaks, Calif.)","volume":"29 1","pages":"235 - 235"},"PeriodicalIF":0.0000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"1","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Foregut (Thousand Oaks, Calif.)","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/26345161231170426","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 1
Abstract
To the editor, I read with great interest the article “The American Foregut Society white paper on the endoscopic classification of esophagogastric junction integrity”1 published in the journal. The newly proposed American Foregut Society (AFS) classification to grade the antireflux barrier (ARB) integrity provides more comprehensive evaluation that are relevant to the practicing clinicians in day-to-day practice. The authors appropriately call for future validation of this novel classification and its correlation with the presence and severity of gastroesophageal reflux disease, and additionally to extend the classification to assess the ARB integrity in individuals with prior antireflux interventions,1 whether surgical or endoscopic. However, the future directions fall short of addressing 2 important variables that may affect the assessment of ARB integrity by applying the AFS classification. First, the classification does not take into consideration the anesthesia effect on the ARB. The hiatal aperture tends to be larger under general anesthesia with use of paralytics as compared to conscious sedation without the use of paralytics. Second, the novel AFS classification does not take obesity into consideration either. It is common to see a large fat pad in the diaphragmatic hiatus during laparoscopy, which may prevent accurate appreciation of a hidden hiatal hernia, whether endoscopically or laparoscopically. Therefore, caution needs to be taken when evaluating for hiatal hernia in obese patients, and other modalities, such as upper gastrointestinal contrast study, should be used to assess for presence of hiatal hernias.2 Addressing these 2 important issues is of paramount importance in future studies. Declaration of Conflicting Interests
对于编辑,我怀着极大的兴趣阅读了1在杂志上发表的文章《the American Foregut Society白皮书on内镜下食管胃结完整性分类》。新提出的美国前肠学会(AFS)分类对抗反流屏障(ARB)完整性进行分级,提供了更全面的评估,与临床医生在日常实践中相关。作者适当地呼吁进一步验证这一新的分类及其与胃食管反流疾病的存在和严重程度的相关性,并进一步扩展分类以评估先前进行过抗反流干预的个体的ARB完整性,1无论是手术还是内镜。然而,未来的方向缺乏解决两个重要的变量,这两个变量可能会影响应用AFS分类对ARB完整性的评估。首先,该分类没有考虑到ARB的麻醉效果。与不使用麻痹剂的清醒镇静相比,使用麻痹剂的全身麻醉下,裂孔孔径往往更大。其次,新的AFS分类也没有考虑肥胖。腹腔镜检查时,在膈裂孔中经常看到一个大的脂肪垫,这可能会妨碍对隐藏裂孔疝的准确判断,无论是内窥镜还是腹腔镜检查。因此,在评估肥胖患者的裂孔疝时需要谨慎,并应采用其他方式,如上胃肠造影研究,来评估裂孔疝的存在在未来的研究中,解决这两个重要问题至关重要。利益冲突声明