Abstract
The HE difficulties in the diagnosis of carcinoma of the gastroesophageal junction and the ease with which it is confused with achalasia<sup>1</sup>and hiatal hernia<sup>2-4</sup>are well known. During the past two years we have had the opportunity to evaluate four patients who proved to have carcinoma of the gastric cardia infiltrating the submucosa of the lower esophagus. In the study of these patients we have been impressed with the value of the observation of peristaltic abnormalities in the distal esophagus above the carcinomatous infiltration. This radiologic sign consisted of transient detention of the barium column at the distal esophagus followed by marked bulging and regurgitation into the proximal esophagus. <h3>Material and Methods</h3> The study of each patient consisted of routine gastrointestinal series, esophagoscopy, gastroscopy, and esophageal biopsy. When the bulging sign was suggested in routine films, cinefluoroscopy was performed where the radiologic abnormality was better appreciated. Histological
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