Endoscopic assessment of the topographic anatomy of the cardia zone from the lumen of the stomach

Objective. Optimization of the assessment of the cardia using innovative methods of retrograde endoscopic examination, in particular, using the criteria of the Japanese group of researchers and the classification of the American Foregut Society (AFS) and identifying the correlation of the detected changes with the severity of GERD. Material and methods. The study included 103 patients aged 20 to 79 years (average — 55±2 years) who were examined and treated in our Clinic from 2021 to 2024. Among them were 14 (13.5%) asymptomatic patients (group 1); 49 (47.5%) patients with GERD, endoscopic cardia insufficiency and/or signs of axial chiatal hernia, who required additional clarifying examination and a decision on the need for surgical treatment (group 2); and 40 (38.8%) patients (group 3) with previously undergone antireflux surgery. We conducted a prospective clinical study with the measurement of all key parameters of the topography of the cardia from the lumen of the stomach and the assessment of the functional state of the esophageal-gastric junction using 24-hour pH impedancometry, high-resolution esophageal manometry and retrograde endoscopically integrated manometry (REIM) of the cardia zone. Results. In the 1st group 85.7% patients had grade 1 AFS classification, which excluded the presence of endoscopic signs of a violation of the locking mechanism of the cardia. In the 2nd group 95.9% of patients were diagnosed with grade II, III, IV destruction of the antireflux barrier according to the AFS classification. This was expressed in a progressive increase in the degree of destruction of the anatomical integrity of the diaphragmatic opening according to the LDF components (length of the axial hernia, divergence of the diaphragm legs, loss of the flap valve) and was closely related to the severity of GERD. In the 3d group only 11/40 (27.5%) confirmed the validity of the locking mechanisms of cardia — grade I AFS, which correlated with the clinical picture and the results of functional studies. Conclusion. The new AFS classification and assessment of the structure and physiology of the esophageal-gastric junction, proposed by Japanese authors, can become universal methods of endoscopic assessment of this zone in patients with GERD. Retrograde endoscopic examination, along with other methods, provides objective information about the state of the antireflux barrier, which is important for making a decision on the need for surgical intervention and evaluating the effectiveness of antireflux surgery.