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Endoscopy 1995; 27(2): 185-190
DOI: 10.1055/s-2007-1005659
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Endosonographic Evaluation of the Patient with Achalasia: Appearance of the Esophagus using the Echoendoscope

J. Van Dam1 , G. W. Falk1 , M. V. Sivak, Jr.1 , E. Achkar1 , T. W. Rice2
  • 1Department of Gastroenterology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
  • 2Department of General Thoracic Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Publication History

Publication Date:
17 March 2008 (online)

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Abstract

Background and Study Aims: Endoscopic ultrasonography (EUS) provides high-resolution images of the esophageal wall and adjacent structures. The purpose of this study was to evaluate the usefulness of EUS using the echoendoscope in the evaluation of patients with achalasia.

Patients and Methods: Seventeen patients with achalasia underwent esophagogastroduodenoscopy (EGD), esophageal manometery, and EUS. The esophageal wall thickness was measured endosonographically in four quadrants at the gastroesophageal junction (GEJ) and at 1 cm intervals proximally. Of the 17 patients evaluated, five had a tortuous esophagus (Group A) and 12 had a relatively straight esophagus (Group B). Six patients without esophageal symptoms served as controls (Group C).

Results: There was no significant difference in the mean esophageal wall thickness measured at the GEJ between the groups (4.0 mm, 3.3 mm, and 2.9 mm for Groups A, B, and C, respectively). Esophageal wall thickness was significantly greater in Group A than Group C when measured 2, 3, and 4 cm above the GEJ (4.2 mm vs. 2.8 mm; 4.1 mm vs. 2.4 mm; 4.0 mm vs. 2.4 mm, respectively) (p < .05). When measured 2 cm above the GEJ, the esophageal wall in Group A patients was significantly thicker (4.2 mm) than in patients in either Group B (3.2 mm) or Group C (2.8 mm) (p < 0.05).

Conclusions: The appearance of esophageal wall thickening was common in patients with achalasia. Positioning of the echoendoscope in some patients with an irregularly-shaped, tortuous esophagus may result in tangential imaging and the production of artifacts simulating submucosal lesions. The production of such imaging artifacts suggests that caution must be exercised when EUS with the echoendoscope is used to evaluate patients with achalasia and a tortuous esophagus. Based on the present level of knowledge, EUS is not recommended in the routine evaluation of patients with achalasia.