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Critical assessment of a new endoscopic anatomic concept for the so-called cardia in the sense of the notions of parmenides and martin heidegger [Kritische Betrachtung neuer Konzepte zur endoskopischen Anatomie des ?sphagogastralen übergangs im Sinne des Denkens von Parmenides und Martin Heidegger]

机译:从帕门尼德斯和马丁·海德格尔的概念出发,对所谓的card门的一种新的内镜解剖学概念进行严格的评估[从帕门尼德斯和马丁·海德格尔的思想出发,对食管胃镜转换的内窥镜解剖学的新概念进行严格的考虑]

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摘要

Current endoscopic anatomy interposes the gastric cardia between the tubular oesophagus and the proximal stomach. In contrast to that, recent evidence unfolds a different view. Using PubMed and Scopus searches, we examined if the novel understanding regarding the cardia goes in line with the concept of unfolding, as described by Heidegger based on the ancient didactic poetry of Parmenides. What has been taken as gastric cardia in fact represents reflux-damaged, dilated, columnar lined oesophagus (CLO): dilated distal oesophagus (DDO). Due to its macroscopic gastric appearance it cannot be discriminated from the stomach by endoscopy. Differentiation between DDE and proximal stomach requires the histopathology of measured multi-level biopsies obtained from the DDO and the proximal stomach. Cardaic, onxytocardiac mucosa and intestinal metaplasia (IM; Barrett's oesophagus) define CLO and thus the oesophageal location, while oxyntic mucosa (OM) of the proximal stomach verifies a gastric biopsy location. Endoscopically visible CLO and DDO define the morphological manifestation of reflux: the squamo-oxyntic gap (SOG). Biopsies obtained from the level of the diaphragmatic impressions allow differentiation between an enlarged hiatus with normal anatomic content (CLO; oesophagus) vs. hernia with abnormal content (OM; stomach). Non-dysplastic Barrett's oesophagus exists in 10 %-17 % of asymptomatic and in 20 %-100 % (with increasing CLO length) of reflux symptom-positive individuals (annual cancer risk: 0.2 %-0.7 %). These data justify biopsy of an endoscopically normal appearing squamocolumnar junction for the exclusion of Barrett's oesophagus and cancer risk. In the absence of contraindications, cancer risk-based therapy of dysplastic Barrett's oesophagus includes radiofrequency ablation (RFA) ± endoscopic resection. The perception of the cardia as reflux damaged DDO mirrors the concept of unfolding, as described by the interpretation of the didactic poem of Parmenides by Heidegger. Our data recommend to omit the term cardia and allocate morphology either to the oesophagus (CLO, DDO) or to the proximal stomach or indicate that allocation is impossible (i. e. tumour-induced). Future studies will have to test the value of this novel concept for diagnosis, treatment of gastro-oesophageal reflux disease and cancer prevention.
机译:当前的内窥镜解剖结构将胃card门置于管状食道和近端胃之间。与此相反,最近的证据提出了不同的观点。使用PubMed和Scopus搜索,我们检查了关于the门的新颖理解是否符合展开的概念,正如海德格尔根据帕门尼德斯古代教义诗所描述的那样。实际上,被视为胃card门的是指反流损伤,扩张的柱状衬里食道(CLO):扩张的远端食道(DDO)。由于其宏观的胃部外观,无法通过内窥镜将其与胃区分开。 DDE和胃近端的区别需要从DDO和胃近端获得的多级活检组织病理学。心脏,心脏粘膜粘膜和肠上皮化生(IM;巴雷特食管)定义了CLO,因此定义了食管的位置,而近端胃的胃黏膜(OM)验证了胃活检的位置。内窥镜下可见的CLO和DDO定义了反流的形态学表现:鳞状氧化性间隙(SOG)。从the肌印模的水平获得的活检标本可以区分正常解剖含量(CLO;食道)的扩大裂孔与异常解剖含量(OM;胃)的疝。非典型增生性巴雷特食管在无症状的10%-17%和反流症状阳性的个体中占20%-100%(随着CLO长度的增加)(年度癌症风险:0.2%-0.7%)。这些数据证明对排除Barrett食道和癌症风险的内镜正常出现的鳞状小柱交界处进行活检是合理的。在没有禁忌症的情况下,基于癌症风险的增生性Barrett食管治疗包括射频消融(RFA)±内窥镜切除术。心脏card门返流受损DDO的感觉反映了展开的概念,正如Heidegger对Parmenides的教义诗的解释所描述的那样。我们的数据建议省略术语card门,并将形态分配给食道(CLO,DDO)或胃近端,或表明不可能进行分配(即由肿瘤引起)。未来的研究将必须测试这一新颖概念对诊断,治疗胃食管反流病和预防癌症的价值。

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