Endosonographic appearance of the esophagus in achalasia

Primary motility disorders of the esophagus require the exclusion of intramural tumors. The procedures currently used for the differential diagnosis of achalasia such as endoscopy with biopsy, esophageal and gastric radiography, abdomino-thoracic computed tomography and intraluminal esophageal manometry, are unsatisfactory when a tumor growing intramurally is suspected. A more recent method of studying the integrity of the gastrointestinal wall and its surrounding tissue is endoscopic ultrasonography. In 16 patients suspected of having achalasia, endosonography was performed in addition to the above-mentioned conventional examinations. Fifteen of them showed a normal ultrasonic structure of the wall of the gastro-esophageal junction, with no sign of hypertrophy of the smooth muscle layer. In the remaining case endoscopic ultrasonography was able to detect an intramural tumor, as evidenced by the inhomogeneous ultrasonic structure of the esophageal wall. Computed tomography and all the other conventional diagnostic procedures used failed to demonstrate this tumor. In conclusion, the findings presented strongly suggest that endosonography can contribute to the differential diagnosis of achalasia and intramural tumors.