Can Esophageal Stıffness and Thıckness Measurement By Transcervıcal Sonoelastography Predıct Reflux Esophagıtıs?

We aimed to investigate the efficacy of transcervical esophageal sonoelastography in discriminating between patients with and without Reflux Esophagitis (RE).

Patients who underwent an esophagogastroduodenoscopy following a transcervical sonoelastographic examination in a tertiary center were included. The thickness and Shear Wave Velocity (SWV) of the submucosa-mucosa, muscularis mucosae, and total esophageal wall were measured by using sonoelastography. Patients were classified into RE-positive (grades A-D according to The Los Angeles Classification) and REnegative groups based on endoscopic findings. The elastosonographic features of RE (-) and RE (+) patients were compared statistically Results: Among the 503 included patients, 129 (25.6%) were RE (+) [(80 grade A (62%), 28 grade B (21.7%), 12 grade C (9.3%), 9 grade D (7%)] and 374 were RE (-). A 31.7% positive correlation between age and Total Wall Thickness (TWT) and a 21% negative correlation between TWT and submucosa-mucosa SWV were detected. The thickness of submucosa-mucosa, muscularis propria, and total wall were significantly higher in RE (+) patients compared to RE (-) patients (p < 0.001 for all). The SWVs of submucosa-mucosa, muscularis propria, and total wall were significantly lower in RE (+) patients compared to RE (-) patients (p < 0.001 for all). A cut-off value of 2.35 mm for TWT yielded 67% sensitivity and 57% specificity, while a cut-off of 2.08 m/s for total wall SWV yielded 79% sensitivity and 81% specificity for the diagnosis of RE.

The significant increase in cervical esophageal wall thickness in RE (+) is consistent with the literature. However, the markedly decreased stiffness is a novel finding demonstrated by this study.

The evaluation of esophageal thickness and stiffness using sonoelastography may be added to routine neck ultrasound scans for the prediction of RE.