Introduction: The gastroesophageal junction is a complex anatomic area. Precise endoscopic assessment of the gastroesophageal junction is of utter importance, especially regarding Barrett's esophagus and neoplasms of the gastroesophageal junction. There has been a lack of a validated definition of the endoscopic gastroesophageal junction.
Methods: Seven patients scheduled for resection of the gastroesophageal junction were included. Before surgery, gastroscopy was performed and the gastroesophageal junction was assessed. If there was disparity between the endoscopic gastroesophageal junction and the Z-line, the gastroesophageal junction was marked with India ink tattooing. Postoperatively the resection specimens were evaluated and the anatomical gastroesophageal junction was compared with the endoscopic.
Results: In all seven patients the measured difference between the gastroesophageal junction and the endoscopic junction was <5 mm.
Conclusions: The upper margin of the longitudinal folds of the stomach can be used as an appropriate endoscopic definition of the gastroesophageal junction.