Analysis of computed tomographic findings according to gastroesophageal flap valve grade.
- Author:
Hye Kyung JEON
1
;
Gwang Ha KIM
;
Nam Kyung LEE
;
Suk KIM
;
Bong Eun LEE
;
Geun Am SONG
Author Information
- Publication Type:Original Article
- Keywords: Gastroesophageal ref lux; Gastroesophageal f lap valve; Endoscopy; Computed tomography; His angle
- MeSH: Endoscopy; Endoscopy, Digestive System; Esophagogastric Junction; Esophagus; Humans; Stomach; Stomach Neoplasms; Subcutaneous Fat
- From:The Korean Journal of Internal Medicine 2018;33(2):295-303
- CountryRepublic of Korea
- Language:English
- Abstract: BACKGROUND/AIMS: The gastroesophageal junction is an important barrier against gastroesophageal ref lux. Endoscopic grading of gastroesophageal f lap valve is simple, reproducible, and may predict reflux activity. We investigated the correlation between gastroesophageal flap valve grade and the gastroesophageal junction’s structural properties using abdominal computed tomography. METHODS: A total of 138 patients with early gastric cancer who underwent both pre-treatment esophagogastroduodenoscopy and water-distended stomach two-phase computed tomography were enrolled. Endoscopic gastroesophageal f lap valve grade and abdominal computed tomography findings were analyzed to assess anatomical factors including the gastroesophageal junction and related organs. RESULTS: The angle of His increased significantly with gastroesophageal flap valve grade (grade I, 65.2˚± 19.6˚; grade II, 66.6˚± 19.8˚; grade III, 76.7˚± 11.9˚; grade IV, 120.0˚± 30.3˚; p < 0.001), as did the size of the diaphragmatic hiatus (grade I, 213.0 ± 53.8 mm2 ; grade II, 232.6 ± 71.0 mm2 ; grade III, 292.3 ± 99.2 mm2 ; grade IV, 584.4 ± 268.3; p < 0.001). The length of the abdominal esophagus decreased as gastroesophageal flap valve grade increased (grade I, 34.6 ± 5.8 mm; grade II, 32.0 ± 6.5 mm; grade III, 24.6 ± 7.8 mm; grade IV, –22.6 ± 38.2 mm; p < 0.001). There was no significant relationship between gastroesophageal flap valve grade and visceral and subcutaneous fat areas (p = 0.877 and p = 0.508, respectively). CONCLUSIONS: Endoscopic grading of the gastroesophageal flap valve is well correlated with anatomical changes around the gastroesophageal junction on abdominal computed tomography, and it can provide useful information about the anti-reflux barrier.
