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New endoscopic indicator of esophageal achalasia: "pinstripe pattern".

Minami H, Isomoto H, Miuma S, Kobayashi Y, Yamaguchi N, Urabe S, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Inoue H, Nakao K - PLoS ONE (2015)

Bottom Line: The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively.PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity.Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

ABSTRACT

Background and study aims: Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia.

Patients and methods: This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, "pinstripe pattern (PSP)" was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding.

Results: The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively.

Conclusion: "Pinstripe pattern" could be a reliable indicator for early discrimination of primary esophageal achalasia.

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Related in: MedlinePlus

Comparison between achalasia (left) and non-achalasia (right) patients using indigocarmine and NBI.
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pone.0101833.g003: Comparison between achalasia (left) and non-achalasia (right) patients using indigocarmine and NBI.

Mentions: The prevalence rate of each finding in the patients with esophageal achalasia is shown in Table 2. Functional stenosis of the EGJ was observed in 94.6% of the cases. However, dilation of esophageal lumen and food/liquid remnant in the esophagus, which are relatively clear indicators, were detected in 41.1% of the cases. Finally, PSP had a prevalence rate of 60.7% (34/56), whereas mucosal thickening and whitish change were observed in only 16.1% (9/56) of the cases. The typical PSP was only observed in patients with achalasia (Fig. 3 a, b). None of the non-achalasia patients showed positivity for PSP, including the cases of superficial esophageal carcinoma, reflux esophagitis and eosinophilic esophagitis (p < 0.001). Accordingly, the overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of PSP for differentiating achalasia were 81.0%, 60.7%, 100%, 100%, and 73.2%, respectively. Twenty-six (62.5%) of the 35 cases that had symptoms for <10 years were positive for PSP. In addition, 20 (71.4%) of the 32 cases without food/liquid remnant in the esophagus showed PSP positivity. PSP that was observed from lower to middle thoracic esophagus disappeared or reduced in 3 to 6 months after POEM procedure in all cases (Fig. 4 a–d). Pathological examination of biopsy specimens taken from the mucosa of pre-treatment achalasia showed no significant histological change but slight thickening of the epithelium. Abnormal turnover of esophageal superficial epithelium due to persistent food stasis could be one of the reasons.


New endoscopic indicator of esophageal achalasia: "pinstripe pattern".

Minami H, Isomoto H, Miuma S, Kobayashi Y, Yamaguchi N, Urabe S, Matsushima K, Akazawa Y, Ohnita K, Takeshima F, Inoue H, Nakao K - PLoS ONE (2015)

Comparison between achalasia (left) and non-achalasia (right) patients using indigocarmine and NBI.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4321991&req=5

pone.0101833.g003: Comparison between achalasia (left) and non-achalasia (right) patients using indigocarmine and NBI.
Mentions: The prevalence rate of each finding in the patients with esophageal achalasia is shown in Table 2. Functional stenosis of the EGJ was observed in 94.6% of the cases. However, dilation of esophageal lumen and food/liquid remnant in the esophagus, which are relatively clear indicators, were detected in 41.1% of the cases. Finally, PSP had a prevalence rate of 60.7% (34/56), whereas mucosal thickening and whitish change were observed in only 16.1% (9/56) of the cases. The typical PSP was only observed in patients with achalasia (Fig. 3 a, b). None of the non-achalasia patients showed positivity for PSP, including the cases of superficial esophageal carcinoma, reflux esophagitis and eosinophilic esophagitis (p < 0.001). Accordingly, the overall accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of PSP for differentiating achalasia were 81.0%, 60.7%, 100%, 100%, and 73.2%, respectively. Twenty-six (62.5%) of the 35 cases that had symptoms for <10 years were positive for PSP. In addition, 20 (71.4%) of the 32 cases without food/liquid remnant in the esophagus showed PSP positivity. PSP that was observed from lower to middle thoracic esophagus disappeared or reduced in 3 to 6 months after POEM procedure in all cases (Fig. 4 a–d). Pathological examination of biopsy specimens taken from the mucosa of pre-treatment achalasia showed no significant histological change but slight thickening of the epithelium. Abnormal turnover of esophageal superficial epithelium due to persistent food stasis could be one of the reasons.

Bottom Line: The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively.PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity.Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.

ABSTRACT

Background and study aims: Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia.

Patients and methods: This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, "pinstripe pattern (PSP)" was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding.

Results: The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively.

Conclusion: "Pinstripe pattern" could be a reliable indicator for early discrimination of primary esophageal achalasia.

Show MeSH
Related in: MedlinePlus