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CLASSIFICATION
Classification
Hill classification (gastroesophageal flap valve)
Retroflexed grades I–IV of the gastroesophageal flap valve. Endoscopic assessment of the antireflux barrier.
Classification overview
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More competent
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Grade I · Prominent fold, closely apposed
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Grade II · Less prominent fold; opens and closes
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Abnormal
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Grade III · Fold not prominent; hernia usual
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Grade IV · No fold; open lumen from below
More competent
Grade I
Prominent fold, closely apposed
Ge 2023, Fig. 1, Not original, CC BY-NC
Definition
A prominent fold of tissue along the lesser curvature that is closely apposed to the endoscope through all phases of respiration
Grade II
Less prominent fold; opens and closes
Ge 2023, Fig. 1, Not original, CC BY-NC
Definition
The fold is present but not as prominent, with periods of rapid opening and closing around the endoscope
Abnormal
Grade III
Fold not prominent; hernia usual
Ge 2023, Fig. 1, Not original, CC BY-NC
Definition
The fold is not prominent and the endoscope is not tightly gripped by the tissue. A hiatal hernia is present in nearly all of these patients
Note: Grades III–IV are more often associated with reflux and hiatal hernia.
Grade IV
No fold; open lumen from below
Ge 2023, Fig. 1, Not original, CC BY-NC
Definition
Essentially no fold, and the lumen of the esophagus is wide open, allowing the squamous epithelium to be viewed from below
Ge 2023, Fig. 1, Not original, CC BY-NC
Reference
Original article
Hill LD et al. Gastrointest Endosc 1996;44:541-547
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