Fig. 7
From: Anti-reflux mucosectomy (ARMS) for refractory gastroesophageal reflux disease
Flap valve score (Hill’s classification). a Grade I = a prominent fold of tissue along the lesser curvature next to the endoscope. b Grade II = the fold is less prominent with spontaneous openings and closings around the endoscope. cGrade III = the fold is not prominent, and the endoscope is not tightly gripped. dGrade IV = no fold is seen and the lumen of esophagus is open in retroflexion, hiatal hernia is always present