Endoscopic ultrasonography in achalasia

Area of Science:

• Gastroenterology
• Medical Imaging
• Diagnostic Endoscopy

Background:

• Achalasia is a primary esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and loss of peristalsis.
• Accurate diagnosis of achalasia is crucial for timely and effective treatment to prevent complications.
• Differentiating achalasia from pseudoachalasia, often caused by malignancy, is clinically important.

Purpose of the Study:

• To evaluate the utility of endoscopic ultrasonography (EUS) in diagnosing achalasia.
• To assess the characteristic EUS findings of the muscularis propria at the LES in achalasia patients.
• To determine if EUS can help differentiate achalasia from pseudoachalasia.

Main Methods:

• Prospective study involving six patients with diagnosed achalasia.
• Endoscopic ultrasonography (EUS) examination performed before any therapeutic intervention (dilatation therapy).
• Focused assessment of the echolayer at the level of the lower esophageal sphincter (LES).

Main Results:

• A typical enlargement of the echolayer, representing the muscularis propria, was observed in 5 out of 6 patients (83%) with achalasia.
• EUS provided detailed visualization of the esophageal wall layers at the LES.
• The findings suggest a distinct sonographic pattern for achalasia.

Conclusions:

• Endoscopic ultrasonography (EUS) is a valuable complementary diagnostic tool for achalasia.
• EUS can reveal characteristic thickening of the muscularis propria at the LES in achalasia.
• EUS aids in differentiating achalasia from pseudoachalasia, particularly when tumor infiltration is suspected.