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New endoscopic classification of the cardiac orifice in esophageal achalasia: Champagne glass sign.

Authors :
Gomi, Kuniyo
Inoue, Haruhiro
Ikeda, Haruo
Bechara, Robert
Sato, Chiaki
Ito, Hiroaki
Onimaru, Manabu
Kitamura, Yohei
Suzuki, Michitaka
Nakamura, Jun
Hata, Yoshitaka
Maruyama, Shota
Sumi, Kazuya
Takahashi, Hiroshi
Source :
Digestive Endoscopy; Sep2016, Vol. 28 Issue 6, p645-649, 5p
Publication Year :
2016

Abstract

Background and Aim Endoscopy, barium esophagram and manometry are used in the diagnosis of achalasia. In the case of early achalasia, characteristic endoscopic findings are difficult to recognize. As a result, the diagnosis of achalasia is often made several years after symptom onset. Therefore, we examined the endoscopic findings of the cardiac orifice in achalasia and propose a new classification. Methods A total of 400 patients with spastic esophageal motility disorders who underwent peroral endoscopic myotomy (POEM) at our hospital between March 2014 and August 2015 were screened for this study. Champagne glass sign (CG) was defined as when the distal end of the lower esophageal sphincter relaxation failure (LESRF) was proximal to the squamocolumnar junction (SCJ) and the SCJ was dilated in the retroflex view. Specifically, CG-1 was defined as a distance from the SCJ to the lower end of LESRF of <1 cm, and CG-2 was defined as a distance ≥1 cm. Results CG-0 was seen in 73 patients (28.0%), whereas the CG sign was seen in 186 patients (71.3%), of whom 170 (65.1%) were CG-1 and 16 (6.1%) were CG-2. Conclusions The CG sign is often observed in esophageal achalasia patients. CG-0 (equal to Maki-tsuki) was observed in 28.0% of achalasia patients only. Its absence with dilated SCJ cannot be used to rule out achalasia. Barium esophagram and manometry should be done if esophageal achalasia is strongly suspected. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
09155635
Volume :
28
Issue :
6
Database :
Complementary Index
Journal :
Digestive Endoscopy
Publication Type :
Academic Journal
Accession number :
117808191
Full Text :
https://doi.org/10.1111/den.12642