Gastroesophageal junction

K. Iijima, E. Henry, A. Moriya, A. Wirz, A.W. Kelman, and K.E.L. McColl, Dietary nitrate generates potentially mutagenic concentrations of nitric oxide at the gastroesophageal junction. Gastroenterology 122, 1248-1257 (2002). 

Schnirer II, Komaki R, Yao JC, et al. Pilot study of concurrent 5-fluorouracil/paclitaxel plus radiotherapy in patients with carcinoma of the esophagus and gastroesophageal junction. Am J Clin Oncol 2001 24(1) 91—95. 

Sandler AB, Kindler HL, Einhorn LH, et al. Phase II trial of gemcitabine in patients with previously untreated metastatic cancer of the esophagus or gastroesophageal junction. Ann Oncol 2000 11 1161-1164. 

Although there are efforts at this time to stratify squamous vs adenocarcinoma, studies to date have not separated these two histologies and, therefore, treatment recommendations have been similar, regardless of histology. The only exception to this generalization is adenocarcinomas of the gastroesophageal junction. 

Although only reported in abstract form, INTO 116, a randomized study of postoperative modality therapy (5-FU, leucovorin, and RT) vs surgery alone in resected adenocarcinoma of the stomach and gastroesophageal junction, has found a statisti-... 

Midesophageal tumors (at or below the carina) are considerably easier to treat. The paraesophageal nodes need to be included but the supraclavicular and celiac nodes do not. These are often treated with AP-PA fields to 3960 cGy followed by obliques to 5040 cGy. Three-field techniques (posterior obliques, with single anterior fields) can also be utilized. Similar techniques are used in treating distal esophageal or gastroesophageal junction tumors. The fields, however, now must include the celiac nodes. 

Safran H, et al. Paclitaxel and concurrent radiation therapy for locally advanced adenocarcinomas of the pancreas, stomach, and gastroesophageal junction. Seminars inRadiation Oncology 1999 9(2 Suppl l) 53-57. 

Macdonald JS, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med 2001 345(10) 725-730. 

Histopathologic validation of lymph node staging with FDG-PET scan in cancer of the esophagus and gastroesophageal junction A prospective study based on primary surgery with extensive lymphadenectomy, Ann. Surg. 232(6) (2000) 743-752. 

Gastroesophageal reflux. Reflux of the stomach and duodenal contents into the esophagus, which may sometimes occur normally, particularly in the distended stomach postprandially, or as a chronic pathological condition. Gastroesophageal. Pertaining to the stomach and esophagus, as the gastroesophageal junction. 

Esophageal adenocarcinomas do not appear to be as responsive [171]. Ajani et al. [172] have studies neoadjuvant EAP (VP-16, doxorubicin, and cisplatin) for patients with adenocarcinomas of the distal esophagus and gastroesophageal junction and observed a 42% response rate 78% of treated patients underwent curative resection and overall median survival was 23 months. 

Barrett esophagus (BE) is defined as intestinal metaplasia in association with endoscopically recognized columnar metaplasia of the gastroesophageal junction. This... 

Glickman JN, Wang H, Das KM, et al. Phenotype of Barrett s esophagus and intestinal metaplasia of the distal esophagus and gastroesophageal junction an immunohistochemical study of cytokeratins 7 and 20, Das-1 and 45 ML Am J Surg Pathol. 2001 25 87-94. 

Jovanovic I, Tzardi M, Mouzas lA, et al. Ghanging pattern of cytokeratin 7 and 20 expression from normal epithelium to intestinal metaplasia of the gastric mucosa and gastroesophageal junction. Histol Histopathol. 2002 17 445-454. 

Fig. 2.20a,b. Gastroesophageal reflux, a During swallowing, the gastroesophageal junction is closed, b The gastroesophageal junction is widely patent, and harium refluxes to the upper esophagus... 

On abdominal X-ray studies, a gastric volvulus maybe suspected. In organoaxial volvulus, a subtle inferiorly displaced gastroesophageal junction may be seen. More typically in mesentericoaxial volvulus, the stomach appears spherical on supine films and a double air-fluid level can be seen in the upright position a superior one in the antrum, and an inferior one in the fundus. On chest radiograph, a ret-rocardiac gas-filled structure, consistent with a diaphragmatic hernia and/or an intrathoracic stomach maybe seen (Fig. 3.5). 

In total, 15-18 migrated Wallstents were deployed across the gastroesophageal junction... 

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