Endoscopic examination of a normal Z-line

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S. Groth and T. Rösch, Hamburg


Sequence 1: initial visualization of the Z-line

To begin with, the area of the Z-line is rinsed free, and the Z-line is then visualized. Esophageal motility repeatedly obstructs viewing.

Sequence 2: visualization of the Z-line without enhancement and with iScan

The Z-line is visualized without enhancement and with iScan. Spasticity in the distal esophagus is obstructing good visualization of the Z-line here. Air is therefore suctioned out of the stomach, so that a better view of the Z-line is obtained during withdrawal.

Sequence 3: staining with acetic acid

1% acetic acid is used to demonstrate the surface structure. An attempt is made to visualize the surface structure of the Z-line despite motility.

Sequence 4: demonstration of the Z-line with the distancing cap

Using a distancing cap, the mucosa is spread apart to allow better visualization of mucosal details in individual areas along the circumference. The whitish acetic acid staining makes the surface structure more visible, and a short tongue of Barrett’s appears on the left. Macroscopically, the rest of the Z-line has gastric mucosa on it.

Sequence 5: examination in inversion

Complete examination of the Z-line includes visualizing it in the inverted position. The Z-line is relatively low here.

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