Radiological landmarks at the oesophago-gastric junction.

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Abstract
The radiological landmarks in the distal esophagus are the vestibule with the inferior esophageal sphincter at its upper limit and the sling fibers of the stomach and transverse mucosal fold at its lower limit (the esophagogastric junction), and the hiatus on deep inspiration. Radiological observations of the hiatus and lower esophagus carrying opaque markers have shown that the hiatus moves forwards as well as downwards on inspiration and that its left wall moves more than its right one. The hiatus only narrows significantly on deep inspiration and its positions may then be determined radiologically. The lower esophagus is streteched to a limited degree on inspiration. Following deglutition, the vestibule elongates as it relaxes, and it shortens again when it contracts. The stripping wave ends at the inferior esophageal sphincter, but, without special techniques to demonstrate this sphincter, a fictitious appearance may be produced of a stripping wave passing right down and through the hiatus. Several different types of inferior esophageal ring and empty segment are described. In patients with a sliding hiatal hernia, a notch on the left due to the sling fibers of the stomach, as well as a ring at the distal end of the vestibule caused by a transverse mucosal fold, mark the position of the esophageal-gastric junction.