Left: Gastric mucosa with longitudinal folds can be seen through the esophagogastric junction. The caliber of the lumen then becomes narrow at the level of the impingement of the diaphragm, signifying the lower edge of the hernia.
Right: Mild, nonobstructing Schatzki ring at the esophagogastric junction, below which the longitudinal gastric folds of the hiatal hernia are visible. Further downward, the lumen becomes narrow where the diaphragm compresses the stomach, at the lower edge of the hernia.
Left: "Sliding" type: The upper portion of the stomach has herniated upward through the diaphragm, and into the thorax. Endoscopically best seen by retroflexing the instrument and viewing from below. The lumen becomes narrow where the diaphragm presses against the stomach. The sliding type of hiatal hernia is in-line with the path of the endoscope.
Center: Paraesophageal type: This retroflexed view shows a portion of the stomach herniating upward through the diaphragm. The path of this type of hernia is adjacent to that of the endoscope.
Right: Combined types: Retroflexed view showing a large sliding type hernia (surrounding the shaft of the endoscope), as well as a second tract (at lower left) which lead upward to a large paraesophageal hernia.
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