DO WE NEED ENDOSCOPIC ULTRASONOGRAPHY FOR THE WORKUP OF PATIENTS WITH ACHALASIA?

Aims:

To assess the clinical contribution of EUS findings in achalasia and other obstructive esophageal motility disorders.

Methods:

We conducted a single centre retrospective study at a tertiary referral centre. We included all patients with an endoscopic ultrasonography for the workup of a suspected secondary esophageal motility disorder from January 2012 to December 2017.

Results:

Sixty-nine patients were included, 52% were men, with a median (± SD) age of 61 ± 14 years. Median (± SD) Eckardt score at time of the EUS was 7 ± 2. Twenty patients had type I achalasia, 27 had type II achalasia and 9 had type III achalasia. Two patients had an esophagogastric junction outflow obstruction syndrome (EGJOOS), 5 had a Jackhammer esophagus, 6 had distal esophageal spasm (DES). EUS was normal in 26 (38%) patients, and showed an esophageal wall thickening in 43 (62%) patients. The inner circular muscle layer was the most frequently thickened, with a mean (± SD) thickness of 2.8 ± 2 mm. Three cases of secondary achalasia were diagnosed: 2 esophageal carcinomas and one eosinophilic esophagitis, all three diagnosed at mucosal biopsies. Esophageal wall thickening was not significantly associated with the type of esophageal motility disorder or achalasia subtype, and there was no statistical correlation between the presence of a wall thickening at EUS and therapeutic outcomes after any of the achalasia treatments.

Conclusions:

In our work, the presence of an esophageal wall thickening was not predictive of achalasia subtype or treatment outcome. The contribution of endoscopic ultrasonography to the workup of esophageal motility disorders seems limited.