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Background: Although multiple treatment options exist for gastroesophageal junction (GEJ) cancer, surgery remains the mainstay for potential cure. Extended nodal dissection with a D2 lymphadenectomy (LAD) remains controversial for Siewert II GEJ cancer. Although D2 LAD may lead to a greater lymph node harvest, its effect on survival remains elusive. The authors hypothesized that additional D2 dissection in Siewert II GEJ cancer does not lead to increased survival. Methods: This study reviewed Siewert II patients who received a D1 or D2 LAD in addition to minimally invasive esophagectomy (MIE) after receiving neoadjuvant chemoradiation or perioperative chemotherapy (2012–2022). The patients were followed for up to 5 years. The outcomes measured were survival, number of nodes sampled, and operative time. The association between D1 or D2 LAD and overall survival was analyzed with Kaplan-Meier methods and a multivariable Cox regression model. Results: Among 155 patients, 74 % underwent D1 and 26 % underwent D2 LAD. The patients with D2 had more than 15 lymph nodes harvested more frequently than those who had D1 (83 % vs 48 %; p < 0.001), with no difference in positive nodes (2.8 ± 5.2 vs 2.1 ± 4.2; p = 0.4). The patients with D2 LAD had a longer median operative time than those who with D1 LAD (362 vs 244 min; p < 0.001). In Kaplan-Meier and multivariable Cox regression models, overall survival did not differ significantly between the patients undergoing D2 and those who had D1 (adjusted hazard ratio [aHR], 0.52; 95 % confidence interval [CI], 0.25–1.00; p = 0.067). Conclusions: Little consensus exists regarding the optimal lymph node harvest for GEJ cancers. In Siewert II cancer, D2 LAD may not be mandatory and may lead to increased operative morbidity with no significant difference in survival. [ABSTRACT FROM AUTHOR]

Background/aimDuring surgical resection of gastroesophageal-junction (GEJ) adenocarcinoma, the margin status is often difficult to visualize resulting in high recurrence rates. The aim of the present study was to develop a labelling technique that would allow improved visualization of GEJ tumor margins for surgeons to reduce recurrence rates in a patient-like model.Materials and methodsA patient GEJ tumor was obtained from an endoscopic biopsy and implanted subcutaneously in a nude mouse. A patient-derived orthotopic xenograft (PDOX) model was established by implanting tumor fragments grown from a subcutaneous model to the cardia of the stomach of nude mice. CC1/3/5-SAB, an antibody to carcinoembryonic-antigen-related cell-adhesion molecules, was conjugated with infrared dye IRDye800 to create SAB-IR800. Forty-eight hours after i.v. injection of SAB-IR800, GEJ-PDOX mice were imaged.ResultsFluorescence imaging with SAB-IR800 brightly visualized the GEJ adenocarcinoma demonstrating specific targeting. In the PDOX model, injection of SAB-IR800 (50 μg) resulted in a tumor to background ratio of 1.78 at 48 hours and 1.86 at 72 hours.ConclusionPDOX models of GEJ tumors can be established from patients by endoscopic biopsy without undergoing surgical resection. GEJ PDOX models should be useful for developing novel diagnostics and therapeutics for this recalcitrant disease.

The signet-ring cell variant of squamous cell carcinoma (SCC) is an extremely rare histological subtype, with only 24 cases (including the present case) reported in the Medline database: 15 affecting the external surface of the body, 3 in the lung, 2 affecting the uterine cervix, 1 involving the gingiva, another one affecting the esophagus and the present case that is the first reported at the gastro-esophageal junction (GEJ). In one case, the location of the lesion was not mentioned. A 59-year-old male patient underwent segmental eso-gastrectomy for carcinoma of the GEJ. The microscopic examination showed a pT3N1-staged SCC composed of solid nests admixed in over 30% of the tumor, with cells having eccentrically located nuclei and clear vacuolated cytoplasm. The signet-ring cells did not show mucinous secretion and were positive for keratin 5/6 and vimentin, with nuclear expression of β-catenin and Sox2 and focal membrane positivity for E-cadherin. Based on these features, the case was considered a signet-ring SCC with epithelial–mesenchymal transition. Thirty-one months after surgery, the patient was disease-free, with no local recurrence and no known distant metastases. In SCC, a signet-ring cell component might be an indicator of the dedifferentiation of tumor cells towards a mesenchymal molecular subtype. [ABSTRACT FROM AUTHOR]

The signet-ring cell variant of squamous cell carcinoma (SCC) is an extremely rare histological subtype, with only 24 cases (including the present case) reported in the Medline database: 15 affecting the external surface of the body, 3 in the lung, 2 affecting the uterine cervix, 1 involving the gingiva, another one affecting the esophagus and the present case that is the first reported at the gastro-esophageal junction (GEJ). In one case, the location of the lesion was not mentioned. A 59-year-old male patient underwent segmental eso-gastrectomy for carcinoma of the GEJ. The microscopic examination showed a pT3N1-staged SCC composed of solid nests admixed in over 30% of the tumor, with cells having eccentrically located nuclei and clear vacuolated cytoplasm. The signet-ring cells did not show mucinous secretion and were positive for keratin 5/6 and vimentin, with nuclear expression of β-catenin and Sox2 and focal membrane positivity for E-cadherin. Based on these features, the case was considered a signet-ring SCC with epithelial–mesenchymal transition. Thirty-one months after surgery, the patient was disease-free, with no local recurrence and no known distant metastases. In SCC, a signet-ring cell component might be an indicator of the dedifferentiation of tumor cells towards a mesenchymal molecular subtype.

Introduction: Gastric cancer remains a challenging malignancy with a high global mortality rate. Recent advances in targeted therapy and immunotherapy have shown promise in improving patient outcomes. This paper reviews the impact of incorporating targeted agents such as trastuzumab and immunotherapeutic agents like pembrolizumab into standard chemotherapy regimens for gastric cancer treatment., Methods: A comprehensive analysis was conducted on pivotal clinical trials, including KEYNOTE-590, KEYNOTE-811, and ToGA, focusing on their methodologies, patient populations, treatment regimens, and outcome measures. The review also explored emerging research avenues in precision medicine, particularly genomic sequencing and biomarker identification., Aim: To assess the efficacy and survival benefits of adding trastuzumab and pembrolizumab to standard chemotherapy in the treatment of gastric cancer and to outline future directions in gastric cancer research., Results: Including trastuzumab and pembrolizumab in treatment regimens for human epidermal growth factor receptor 2 (HER2)-positive and PD-L1-expressing gastric cancers significantly improved progression-free and overall survival rates compared to chemotherapy alone. These findings highlight the potential of personalized therapy in enhancing treatment outcomes. Furthermore, ongoing research into the gastric cancer microenvironment and the role of the microbiome suggests novel targets for future therapeutic interventions., Conclusion: The integration of targeted and immunotherapeutic agents with traditional chemotherapy represents a pivotal shift in gastric cancer treatment, moving towards more personalized and effective regimens., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

A 5-year-old girl presented with abdominal pain, dysphagia, respiratory distress, and fever for the past 3 weeks. The pain was dull in character; present in the epigastrium and right hypochondrium. The patient was unable to swallow solid food and there was difficulty in swallowing even semi-solids and liquids. On examination, there was decreased air entry on the right side with epigastric tenderness. The radiological evaluation suggested caudate lobe liver abscess in close relation with abdominal esophagus resulting in mild compression at gastro-esophageal junction. Pleural effusion on the right side was drained. Broad-spectrum antibiotics including amoebicidal therapy resulted in the dissolution of symptoms and rapid recovery. Caudate lobe liver abscess may result in dysphagia (as its unusual complication) due to inflammation and extraluminal compression at gastro-esophageal junction.

Background: The mechanisms associated with gastro‐esophageal reflux (GER) episodes were studied using combined High‐resolution Impedance Manometry (HRIM) and pH monitoring in ambulant subjects with different patterns of GERD. Methods: Sixteen subjects with mild‐moderate esophagitis (Los Angeles (LA) grade A&B) (group A) and 11 subjects with severe esophagitis (LA grade C&D) or Barrett's esophagus (BE) were studied before and after a meal, resting, while walking, and during standardized exercise, using a HRIM and a pH probe. Key Results: Post‐prandial acid GER episodes were more common in group B (median 10 range (3‐18) vs A (6.5 (0‐18), p = 0.048). Postprandial acid clearance time was much longer in group B (median 0.71(0.07‐2.66 min) vs A (0.17 (0.04‐2.44 min), p = 0.02). Transient lower esophageal sphincter relaxation (TLESR) was the most frequent mechanism associated with GER episodes in both groups. Post‐prandial TLESRs with GER were more common in group B (median 17 (9‐24) vs A 13.5 (7‐34), p = 0.014), particularly during exercise (B 8 (6‐9) vs A 6 (5‐6.8), p = 0.007). Post‐prandially TLESR with acid reflux increased during exercise in both groups (A rest median 2.4 (0‐6.4) per hour vs exercise 4.7 (0‐17.3), p = 0.005 and B 4 (0.8‐9.6) vs 5.3 (2.7‐13.3) per hour, p = 0.045). Conclusions and Inferences: TLESR was the most common mechanism associated with reflux episodes in all subjects. Acid reflux episodes were more common in subjects with severe esophagitis or BE and esophageal acid clearance was much slower. Post‐prandial exercise increased TLESR with acid reflux and GERD patients should be encouraged to avoid exercise immediately after a meal. [ABSTRACT FROM AUTHOR]

A 5-year-old girl presented with abdominal pain, dysphagia, respiratory distress, and fever for the past 3 weeks. The pain was dull in character; present in the epigastrium and right hypochondrium. The patient was unable to swallow solid food and there was difficulty in swallowing even semi-solids and liquids. On examination, there was decreased air entry on the right side with epigastric tenderness. The radiological evaluation suggested caudate lobe liver abscess in close relation with abdominal esophagus resulting in mild compression at gastro-esophageal junction. Pleural effusion on the right side was drained. Broad-spectrum antibiotics including amoebicidal therapy resulted in the dissolution of symptoms and rapid recovery. Caudate lobe liver abscess may result in dysphagia (as its unusual complication) due to inflammation and extraluminal compression at gastro-esophageal junction. [ABSTRACT FROM AUTHOR]

Introduction: Gastric volvulus is a rare cause of acute or recurring abdominal pain in adults, with significant mortality and morbidity. Gastric volvulus is rotation of stomach along its axis, causing gastric outlet obstruction and can result in ischaemia and infarction. Aim: Evaluation of differentiating findings of organoaxial, and mesenteroaxial types of gastric volvulus on Multidetector Computed Tomography (MDCT). Materials and Methods: This was a retrospective study of 20 cases of radiologically suspected cases of gastric volvulus, extracted by keyword search (gastric volvulus) from our reviewed Teleradiology RIS/PACS between the periods Nov-2014 to May-2017. The age group, gender and presenting symptoms of cases were evaluated and statistically analysed. Differentiating CT features of organoaxial volvulus and mesenteroaxial volvulus were evaluated and analysed. Results: In our study, 80% cases were of the organoaxial type of gastric volvulus, while the remaining 20% were of mesenteroaxial type. Mean age of presentation was 77 years with higher incidence among older population. 65% of the patients in our study were females. The majority (85%) in our series presented with classical abdominal pain, nausea and vomiting, and the presence of a hiatal hernia. In our series MDCT was helpful in diagnosing gastric volvulus based on abnormal axis of rotation (100% of both OAV and MAV) and abnormal location of the pyloric antrum above the fundus (85% of OAV). Pylorus lying above the gastroesophageal junction is a differentiating feature (100% of cases of MAV). Conclusion: MDCT is useful in diagnosing gastric volvulus as well as in differentiating OAV and MAV types by specific findings such as axis of rotation of the stomach, position of GEJ, pylorus, greater and lesser curvatures.

Since the first successful esophagectomy for cancer in 1913 spectacular advancements have been made in diagnosis, staging, and therapy. Refinement of imaging, surgery, perioperative management together with multidisciplinary collaboration are the cornerstones. Today therapy with curative option is offered to more patients than ever. Further innovations in imaging, molecular biology, genetics, artificial intelligence, machine learning, robotics, nanotechnology will have an increasing impact. The end result being a unique therapeutic plan shaped on each patient's individual profile., (© 2022 Wiley Periodicals LLC.)

Adenocarcinoma of the gastro-esophageal junction (GEJ) remains a significant clinical problem that is increasing in incidence and is associated with a poor prognosis. The majority of patients present with advanced disease and less than 50% undergo curative treatment. To diagnose GE junction mass with conventional procedure like Barium swallow where endoscopy cannot be performed, CECT is done to access the potential spread of disease. [ABSTRACT FROM AUTHOR]

A rare complication of ventriculoperitoneal (VP) shunt is presented. A 11-year old boy presented with a tube coming out of the mouth. He had multiple VP shunt done earlier. Clinical features, laboratory investigations and imaging studies showed that the peritoneal end had perforated the gastro-oesophageal junction and then prolapsed trans-orally. The shunt was removed and he made an uneventful recovery. Though migration of the peritoneal end of the shunt tube into various organs is known, to our knowledge, only six/seven cases have been reported in the English literature of a shunt tube coming out of the mouth and this is the next. The management of this very rare problem is discussed. [ABSTRACT FROM AUTHOR]

Eph receptors and ephrin ligands are cell–cell communication molecules with well-defined roles in cell adhesion, migration, and tissue boundary formation. However, their expression levels in the squamocolumnar epithelial junction region at the distal esophagus are completely unknown. We examined EphB2 and ephrin-B1 localization in the squamocolumnar epithelial junction region between the proximal and distal stomach of the rodents. Immunostaining showed complimentary expression patterns along the proximal-to-distal axis of the gastric epithelia across the junction: EphB2 expression was maximal around the epithelial junction and sharply decreased in the stratified squamous epithelium at a short distance from the junction, whereas ephrin-B1 was strongly expressed in the stratified squamous epithelium at a distance from the junction and sharply decreased toward the junction. These expression patterns suggest that EphB2/ephrin-B1 signaling occurs preferentially in the epithelia across the junction, where the receptor and ligand expression highly overlap. We also show that (1) EphB2 preferentially binds ephrin-B1, and (2) cell repulsion/lateral migration was induced in primary cultured gastric keratinocytes on ephrin-B1-Fc- and EphB2-Fc-coated surfaces. On the basis of these findings, we propose that EphB2 and ephrin-B1 are possibly involved in epithelial boundary formation at the squamocolumnar junction. [ABSTRACT FROM AUTHOR]

Purpose: Multimodality therapy leads to improved outcomes for adenocarcinoma of the distal esophagus and gastroesophageal junction (GEJ) over surgery alone. At our institution, adjuvant chemoradiation (chemoRT) using IMRT and SIB is standard of care for resected high-risk disease. In this study, we review our experience with a recent cohort of patients treated in this manner. Methods and materials: We identified 18 patients with resected T3 and/or N1 adenocarcinoma of the distal esophagus and GEJ who received adjuvant chemoRT. A large elective volume (PTV1) and a smaller high-risk volume (PTV2) were irradiated simultaneously using IMRT and an SIB technique. All patients received concurrent chemotherapy. Relevant clinical outcomes are reported. Results: The median dose to 95% of PTV1 was 3747cGy and to 95% of PTV2 was 4876cGy. All RT was given in a median of 28 daily fractions. Four patients did not complete chemotherapy. At a median follow up of 952 days from the start of RT, 7 of 18 patients were dead; of these, 3 had developed local recurrence only; 3 had developed both local and distant recurrence; 1 died of a late toxicity, without recurrence. OS was 88% at 1year, 76% at 2 years and 58% at 3 years. Freedom from local recurrence was 88% at 1 year, 82% at 2 years and 82% at 3 years. Freedom from distant recurrence was 72% at 1 year, 67% at 2 years and 56% at 3 years. Toxicity was acceptable. Conclusions: Adjuvant concurrent chemoRT with IMRT and SIB is feasible for resected high-risk adenocarcinoma of the distal esophagus and GEJ. Our results describe how modern treatment techniques can be employed as part of a treatment paradigm that is neither commonly used nor commonly described in the literature. [ABSTRACT FROM AUTHOR]

Background Proximal displacement of the gastro-esophageal junction (GEJ) is present in hiatus hernia but also occurs transiently during transient lower esophageal sphincter relaxations (TLESRs) and swallows. Using a novel magnetic-based technique we have performed detailed examination of the GEJ movement during TLESRs and swallows in healthy subjects. Methods In 12 subjects, a magnet was endoscopically clipped to the GEJ and combined assembly of Hall-Effect locator probe and 36 channel high-resolution manometer passed nasally. After a test meal the subjects were studied for 90 min. Key Results The median amplitude of proximal movement of GEJ during TLESRs was 4.3 cm (1.6-8.8 cm) and this was substantially greater than during swallowing at 1.2 cm (0.4-2.7 cm), P = 0.002. With both TLESRs and swallows proximal GEJ movement coincided with lower esophageal sphincter (LES) relaxation and return to its original position occurred 4 s after return of LES tone. Kinetic modeling of the movement of the GEJ during TLESRs indicated two return phases with the initial return phase having the greater velocity (0.9 cm s−1) and being strongly correlated with amplitude of proximal movement ( r = 0.8, P < 0.001). Conclusions & Inferences The marked proximal GEJ migration during TLESRs represents very severe herniation of the GEJ. The rapid initial return of the GEJ following TLESRs when the crural diaphragm is relaxed and its correlation with amplitude suggest it is due to elastic recoil of the phreno-esophageal ligament. The marked stretching of the phreno-esophageal ligament during TLESRs may contribute to its weakening and development of established hiatus hernia. [ABSTRACT FROM AUTHOR]

Background The function and structure of the gastro-esophageal junction (GEJ) determine its efficacy as a reflux barrier. This study presents a novel methodology for the quantitative assessment of GEJ and proximal gastric morphology from magnetic resonance (MR) imaging. Based on this data we propose a new conceptualization of the hypothesis that a flap valve mechanism contributes to reflux protection. Methods 3D models of the GEJ and proximal stomach were reconstructed from MR images in 12 healthy volunteers during respiration and on eating a test meal to maximum satiation. A rotating plane analysis measured the gastro-esophageal insertion angle and span of contact. An ellipsoid fit provided quantitative assessment of gastric shape and orientation relative to a fixed anatomical reference point. Position of the esophageal insertion on the 'gastric ellipse' was noted. An ellipsoid-cylinder model was designed to analyze the relationships among parameters describing the GEJ morphology. Key Results The insertion angle became more acute on expiration, but did not change with meal ingestion. In contrast the span of contact did not vary with respiration, but increased with gastric filling. Changes in gastric morphology with distension further augmented the span of gastro-esophageal contact in almost 70% of the studies. Conclusions & Inferences Novel MR imaging and biophysical analysis of the GEJ and proximal stomach provide a quantitative description of structures contributing to the reflux barrier. Changes in these parameters during respiration and on eating support the hypothesis that structural components of a functional 'flap valve' like mechanism contribute to reflux protection. [ABSTRACT FROM AUTHOR]

Abstract: Contiguous regions along the mammalian gastrointestinal tract, from the esophagus to the rectum, serve distinct digestive functions. Some organs, such as the esophagus and glandular stomach or the small bowel and colon, are separated by sharp boundaries. The duodenal, jejunal and ileal segments of the small intestine, by contrast, have imprecise borders. Because human esophageal and gastric cancers frequently arise in a background of tissue metaplasia and some intestinal disorders are confined to discrete regions, it is useful to appreciate the molecular and cellular basis of boundary formation and preservation. Here we review the anatomy and determinants of boundaries and transitions in the alimentary canal with respect to tissue morphology, gene expression, and, especially, transcriptional control of epithelial identity. We discuss the evidence for established and candidate molecular mechanisms of boundary formation, including the solitary and combinatorial actions of tissue-restricted transcription factors. Although the understanding remains sparse, genetic studies in mice do provide insights into dominant mechanisms and point the way for future investigation. [Copyright &y& Elsevier]

Abstract Purpose: To evaluate whether location of the gastro-esophageal junction (GEJ) could be determined with the same accuracy on radiography as by manometry with special reference to pH probe positioning. Material and Methods: Ninety patients with suspected esophageal motility disorders underwent simultaneous manometry and video-radiography. The lower esophageal sphincter pressure (LESP) and location was determined, and pressure recordings were made in the body of the esophagus. The GEJ and any structural changes were diagnosed on radiography during single-barium swallows and continuous barium drinking. Simultaneous radiographic and manometric investigations were performed with the pressure-catheter placed 5 cm proximal to the superior border of the GEJ located by manometry, and the distance to the radiographically determined superior border could be measured directly on the videotapes using a radiopaque metric ruler placed under the patient. Results: On radiography, the GEJ proved to be situated < 2 cm distally as compared to its location determined by manometry in 95.6% of the patients, and the maximal difference was 2.5 cm. The LESP or structural changes had no significant influence on the results. Conclusion: The variation of location of GEJ on radiography as compared with manometric findings was sufficiently small to accept both methods as valid in the positioning of the pH probe properly. [ABSTRACT FROM AUTHOR]

• Perforating intra-abdominal injuries are often fatal. • We report perforating intra-abdominal organ injuries with rare GEJ perforation despite blunt trauma to the abdomen. • Early suspicion and laparotomy to manage all the potential injuries along with effective resuscitation and prehospital care are critical. • Esophageal perforations are common with high velocity automobile accidents, crush injuries and endoscopic interventions. • Most common perforations occur along the cervical esophagus followed by distal esophagus. Blunt abdominal trauma causing Gastro-esophageal junction (GEJ), diaphragm, and gastric perforation in children is a very rare occurrence. However, the injury is serious and life-threatening with significant morbidity and mortality. We report an unusual case of a 14-year-old boy with an accidental fall from the tree with blunt abdomen trauma with a perforating injury to GEJ, stomach, and diaphragm. Multiple vital organs in the abdominal cavity are vulnerable to damage in blunt abdominal trauma. The rarity of perforation, diagnostic delay, and early septic occurrence sums up to higher patient morbidity and mortality. A high degree of suspicion and urgent laparotomy and surgical repair forms the cornerstone in management. Early suspicion along with effective resuscitation and early laparotomy and surgical repair is crucial for survival and optimal outcome of the patient. [ABSTRACT FROM AUTHOR]

Background: For locally advanced Siewert type II and III tumors we have performed total gastrectomy including resection of the distal 2/3 of the esophagus, through separate abdominal and right chest incisions (THX-ABD). The procedure involves wide lymphadenectomy in the abdomen/chest and a Roux-en-Y jejunostomy to the level of the azygos vein or above. The aim of the study was to investigate short- and long-term results for this rarely used procedure., Methods: Retrospective study of 83 radio-chemotherapy naïve patients with adenocarcinoma at the gastro-esophageal junction (Siewert type II n = 65 and type III n = 18) operated upon 1986-2011., Results: 2/83 (2.4%) patients died in hospital. 70/83 (84%) patients had R0-resections. 82/83 (99%) patients had free longitudinal resection margins. Overall 5-year survival was 22/83 (27%)., Conclusion: THX-ABD can be performed with high rates of R0 resections and with low in-hospital mortality. Long-term survival rate was not better compared with less extensive surgical procedures., (Copyright © 2018 Elsevier Inc. All rights reserved.)

In the modern era of surgery, minimally invasive surgery is increasingly applied for excision of gastrointestinal stromal tumors. Site, size and tumor location are important factors that affect the surgical approach and excision. We performed a laparoendoscopic transgastric enucleation of a 4-cm pericardial endophytic gastrointestinal stromal tumor (GIST) using an energy device. The surgery was successful and post-operative recovery uneventful. No tumor recurrence was detected on surveillance gastroscopy. In the safe hands of a well-trained laparoscopic upper gastrointestinal surgeon, pericardial GIST can be enucleated safely by this method. The avoidance of surgical staplers is not only cost-effective, but also reduces the risk of associated complications.

Objective: An important premise for obtaining diagnostically relevant histology specimens is an appropriate biopsy technique. Goal of this study was to determine if biopsies of adequate quality can be obtained from the canine esophagus at the gastro-esophageal junction (GEJ) during routine upper gastrointestinal endoscopy., Material and Methods: Over the course of one year, 58 dogs undergoing upper gastrointestinal endoscopy because of the presence of esophageal (n = 22) or gastrointestinal (n = 36) clinical signs were prospectively included. Five biopsies were repeatedly collected from the same dorsal and ventral locations of the GEJ, fixated individually in 4% neutral buffered formaldehyde, and evaluated histopathologically after standard preparation and haematoxylin and eosin staining. The presence of esophageal squamous epithelium with a basal cell layer and lamina propria mucosae in conjunction with foveolar columnar epithelium and cardiac glands, and the absence of fundic glands in one specimen, respectively, was judged as an adequately sampled biopsy., Results: Adequately sampled biopsies were reported in 45 out of 58 dogs, with 31 samples originating from the dorsal GEJ, 36 samples originating from the ventral GEJ, and with 22 samples originating from both sites, respectively. The incidence of adequately sampled biopsies increased significantly over time (r = 0,22; p < 0,05), with these biopsies being reported significantly more often during the last 6 months compared to the first 6 months of the study (p = 0,03). Histopathological evaluation of the esophageal squamous epithelium showed fibrosis, inflammation, elongation of the stromal papillae, and increased thickness of the basal cell layers in 14 out of 58 dogs. Stromal papillae of the ventral esophageal epithelium were significantly elongated in dogs with esophageal clinical signs compared to dogs with gastrointestinal clinical signs (p = 0,03)., Conclusion and Clinical Relevance: After an initial learning phase adequate esophageal biopsies from the GEJ can be obtained in canine patients undergoing upper gastrointestinal endoscopy, and histological lesions can be found in these biopsies.