Click on image to enlarge and advance with cursor over border; Irregular GE junction defined best with NBI (narrow band imaging)
return to: Swallowing Disorders Management Protocols, Laryngeal leukoplakia white plaques on vocal cords; Esophagectomy: Transhiatal-Laparotomy with Cervical Anastomosis
see also: Narrow band imaging of vocal cord leukoplakia flexible transnasal videolaryngoscopy and Fundic Polyps In Patient on Proton Pump Inhibitors
Initial evaluation of GE junction via flexible fiberoptic esophagosocpy showed irregularity that was markedly enhanced with NBI (narrow band imaging) to improve evaluation and directed biopsy.
Pathology report (edited): Gastroesophageal junction, biopsy: Squamocolumnar junctional mucosa with changes consistent with reflux. No Barrett's metaplasia identified.
The Los Angeles (LA) classification system is in common use to grade reflux esophagitis (Nguyen 2019)
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LA Classification System (Lundell 1999) |
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Grade |
Description |
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A |
Mucosal breaks (one or more) ≤ 5 mm length - not extending between the tops of 2 mucosal folds |
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B |
Mucosals breaks >5 mm long - not extending between the tops of two mucosal folds |
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C |
Mucosal breaks continuous between the tops of 2 or more mucosal folds, involving less than 75% of the circumference |
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D |
Mucosal breaks involving 75% or more of the esophageal circumference |
References
Lundell LR, Dent J, Bennett JR, et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut. 1999;45:172–180.
Nguyen AD, Spechler SJ, Shuler MN, Souza RF, Dunbar KB. Unique Clinical Features of Los Angeles Grade D Esophagitis Suggest That Factors Other Than Gastroesophageal Reflux Contribute to its Pathogenesis. J Clin Gastroenterol. 2019;53(1):9-14. doi:10.1097/
Muto M, Minashi K, Yano, T, et al. Early Detection of superficial squamous cell carcinoma in the head and neck region and sophagus by narrow band imaging: A multi-center randomized controlled trial, J Clin Oncolo.2010; 29:1566-72
Takenaka R, Kawahara Y, Okada H, et al. Narrow-band Imaging provides reliable screening for esophageal malignancy in patients with head and neck cancers. Am J Gastroenterol, 2009; 104: 2942-8
Hamanoto Y, Endo T, Nosho K, Arimura Y, Sato M, Imai K. Usefulness of narrow-band imaging endoscopy for diagnosis of Barrett's esophagus. J Gastroenterol, 2004; 39: 14-20
Singh R, Anagnostopulos GK, Yao K et al. Narrow-band imaging with magnification in Barrentss' Esophagus: validation of a simplified grading system of mucosal morphology patterns against histology. Endoscopy 2008: 40: 457-63