Esophageal introitus (with videos).

For GI endoscopists and otolaryngologists, esophageal introitus (EI) is an arbitrary yet overlapping boundary. Many times, the term EI is used interchangeably with pharyngoesophageal sphincter or upper esophageal sphincter. In this review, the authors broadened the definition of EI to cover the lower part of the hypopharynx posterior to the larynx, the esophageal opening posterior to the cricoid prominence, and the area between the bilateral pyriform fossae and the cervical esophagus (Fig. 1). Although much pathology can be observed within this region, careful and systemic examination of the EI often is not stressed enough during GI endoscopic training and practice. The authors demonstrate its anatomy, endoscopic findings, and pathologies within EI and their management. Dysphagia is a common symptom in patients with oropharyngeal or esophageal pathologies and is generally categorized into 2 types of dysphagia: oropharyngeal and esophageal. We prefer the term pharyngoesophageal dysphagia to describe dysphagia occurring within the EI, whereas oropharyngeal dysphagia more specifically refers to symptoms related to oropharyngeal pathologies, such as myasthenia and thyrotoxicosis. Therefore, dysphagia may be categorized into 3 types: oropharyngeal, pharyngoesophageal, and esophageal. Esophageal dysphagia refers to symptoms related to esophageal pathologies distal to the EI. The complete 1-hour digital video content pertaining to this review was published recently by the American Society for Gastrointestinal Endoscopy and is available at http://portal.asge.org/