Definition of the Esophagogastric Junction A Critical Mini Review

Context.-Accurate diagnosis of diseases involving the esophagogastric junction (EGJ) is challenging because of difficulty in defining the EGJ endoscopically and histologically. Recent research results have redefined the EGJ, and the endoscopic and histologic diagnostic criteria of the mucosal EGJ have become available. Objective.-To review the recent literature on endoscopy, histology, and pathology of the EGJ with critical analysis. Data Sources.-Recently published research articles and guidelines in the peer-reviewed core journals and personal research results in this field. Conclusions.-At present, the mucosal EGJ can be defined endoscopically as the distal ends of esophageal longitudinal vessels that meet the proximal ends of gastric longitudinal mucosal folds. However, histologic validation of this criterion is needed. The histologic criteria of the EGJ include the distal ends of esophageal squamous mucosa, deep esophageal glands or ducts, or multilayered epithelium. The squamocolumnar junction is not a reliable landmark of the EGJ in patients with diseases involving the EGJ, such as hiatal hernias. (Arch Pathol Lab Med. 2011;135:384-389)