Endosc Int Open 2014; 2(03): E178-E182
DOI: 10.1055/s-0034-1377319
Original article
© Georg Thieme Verlag KG Stuttgart · New York

In vivo histopathological assessment of the muscularis propria in achalasia by using endocytoscopy (with video)

Hiroki Sato
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
,
Haruhiro Inoue
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
,
Haruo Ikeda
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
,
Chiaki Sato
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
,
Esperanza Grace R. Santi
2   Department of Gastroenterology, De La Salle University Medical Center, Philippines
,
Chainarong Phalanusitthepha
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
,
Yutaka Aoyagi
3   Division of Gastroenterology, Niigata University Medical and Dental Hospital, Japan
,
Shin-ei Kudo
1   Digestive Disease Center, Showa University, Northern Yokohama Hospital, Japan
› Institutsangaben
Weitere Informationen

Publikationsverlauf

submitted23. April 2014

accepted after revision 05. Mai 2014

Publikationsdatum:
10. Juli 2014 (online)

Background: The histopathology of the muscularis propria (MP) is unknown in patients with achalasia. Endocytoscopy (EC) was developed as an ultra-high magnification endoscopy, and the submucosal tunnel created during peroral endoscopic myotomy (POEM) not only provides access to the MP but also enables subsequent endoscopic assessment of the MP.

Patients and methods: In seven patients with achalasia (mean ± SD; 35 ± 18.1 years; men:women, 4:3) who underwent POEM (myotomy length: 12 ± 2.2 cm), subsequent EC examination was performed from the mid-esophagus to the gastric side. EC images were compared to the results of histopathologic examination (two biopsies from the mid-esophagus and lower esophageal sphincter), which was the standard.

Results: In all patients, favorable EC images were obtained, and spindle-shaped smooth muscle cells were detected. In our series, we observed no notable features such as atrophy or hypertrophy of smooth muscle cells. In addition, the EC assessment was consistent with the results of biopsy. No complications were encountered during any of the procedures.

Conclusion: In a clinical setting, real-time assessment of the MP using EC is feasible. This technique may play an important role in determining the pathology of achalasia and other diseases that affect gastrointestinal function.

 
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