Lugol dye endoscopy for analysis of esophageal mucosa in achalasia

Esophageal cancer in achalasia is often diagnosed in the advanced stage, which makes for a poor prognosis. Therefore, the aim of this report is to analyze the macroscopic features of the esophageal mucosa, employing lugol's solution in order to improve the early detection of carcinoma.

From April 1994 to January 1996, the macroscopic features of esophageal mucosa were studied in 64 patients with chagasic or idiopathic achalasia. Conventional endoscopy was employed using lugol's solution for staining.

Macroscopically, the mucosa was classed as normal (22 cases), with opacification (22 cases) or with opacification and surface irregularities (20 cases). Conventional endoscopic examination failed to identify any neoplastic lesion in this series. However, upon staining, unstained or poorly stained areas were observed in 11 patients, and in one of these, at the opacified mucosa with irregularities, the poorly stained area was diagnosed as intraepithelial neoplasia.

Slight macroscopic changes that are characteristic of intramucous carcinoma may not be noticeable in the altered mucosa of achalasia found in about two-thirds of patients. By using lugol, the outline of unstained or poorly stained areas permits directed biopsies. This procedure was important in the detection of histological changes, especially the early diagnosis of esophageal carcinoma, which could not be diagnosed by conventional endoscopic examination.