Hiatus hernia according to the modified makuuchi classification (hh)

    Hiatus hernia according to the modified Makuuchi classification (HH)

    The grades of HH:

    Grade 0: no HH

    Grade 1: partially HH

    Grade 2: complete HH <3cm

    Grade 3: complete HH ≥ 3cm

    Measured by the scale on the endoscopic shaft

    HH on retroflexed endoscopy

    Grade I: Normal edge of tissue closely approximated to the scope

    Grade II: Ridge is slightly less well defined and opens with respiration

    Grade III: Ridge is effaced and the hiatus is patulous

    Grade IV: Hiatus is wide open at all times and displaced axially

    •Δ +: X ray

    •Treatment:

    –Medicines: PPI for GER symptoms

    –Surgery: medical therapy not respond

    The grade of Barrett Esophagus (BE)

    BE: is extension of salmon-colored mucosa into the tubular esophagus extending ≥1cm proximal to the gastroesophageal junction and intestinal metaplasia on biopsy

    • Grade 0: no BE

    • Grade 2: circumferential [C]

    or tongue [T] type, longest BE <1 cm

    • Grade 2: C type, 3cm > longest

    BE ≥1cm or T type, longest BE ≥1cm

    • Grade 3: C type, shortest BE ≥3cm

    Measured by the scale on the endoscopic shaft

    Initial Management

    •Biopsy: at least 8 random biopsies or 4 biopsies/cm of circumferential BE, and one biopsy/cm in tongues of BE

    •Histology Δ +: intestinal metaplasia

    •Treatment:

    –PPI

    –Endoscopy

    –Surgery

    •Repeat endoscopy: every 3 months to 5 years depends on grade and histolog

     

     

     
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