Distance of Cricopharynx During Oesophagoscopy

Clinical Application During Oesophagoscopy

• The American Society for Gastrointestinal Endoscopy recommends recording distances from the incisors for all anatomical landmarks encountered, including the Z-line position, which should be recorded in centimeters from the incisors 1, 2
• The American Society for Gastrointestinal Endoscopy suggests that Barrett's islands and visible lesions should include distance measurements from the incisors 1, 3
• The National Comprehensive Cancer Network defines resectable esophageal carcinomas as those >5 cm from the cricopharyngeus, while cervical or cervicothoracic lesions <5 cm from the cricopharyngeus should receive definitive chemoradiation rather than surgery 4

Important Caveats

• Anatomical variations must be considered, as the cervical esophagus lies predominantly to the left of the midline, with 50% of subjects showing the esophagus posterolateral to the cricoid ring, mainly on the left side, according to the American Society of Anesthesiologists [5 is ignored because it is from 'Praxis Medical Insights', instead 6 is used]
• Individual patient factors including neck extension, body habitus, and anatomical anomalies can alter these measurements, as stated by the American Society of Anesthesiologists 6