Background Endoscopic gastroesophageal junction laxity under retroflexed view is a validated anatomical surrogate for the hiatal long diameter and correlates with objective markers of gastroesophageal reflux disease (GERD), supporting its use in guiding invasive treatment selection. However, routine observations indicate a noticeable discrepancy between endoscopic laxity and true hiatal enlargement in a subset of patients. The present study was conducted to evaluate this discordance and compare their predictive value for key GERD parameters. Methods We retrospectively reviewed patients who underwent both endoscopy and CT in our center. Endoscopic gastroesophageal laxity was measured during retroflexed view, while the hiatal long diameter was measured directly on axial CT images. Concordance between the two methods was assessed. The predictive value of each method for ≥grade B esophagitis was assessed in the full cohort, in a subgroup with pH-impedance monitoring, we further evaluated their ability to predict pathological acid reflux. Results Among 680 included patients, notable discrepancies were observed in 21.3% of cases: 9.7% had a smaller hiatal long diameter than endoscopic laxity, and 11.6% had a hiatal diameter at least twice the endoscopic laxity. Both measures demonstrated similar predictive performance for ≥grade B esophagitis (AUC: 0.77 vs 0.75) and pathological acid reflux (AUC: 0.68-0.69 vs 0.70), including within subgroups exhibiting measurement discrepancy. Conclusions Endoscopic and CT-based assessments of gastroesophageal junction laxity are discordant in approximately 20% of patients. Nevertheless, both methods exhibit comparable and moderate predictive value for key GERD-related parameters.
Chen et al. (2026) studied this question.