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

Abstract

Back ground 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 the 400 patients with spastic esophageal motility disorders whom underwent peroral endoscopic myotomy (POEM) at our hospital between March 2014 and August 2015 were screened for this study.

The "Champagne Glass sign" (CG) was defined as when the distal end of LESRF was proximal to the 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 less than 1 cm, and CG-2 was defined as a distance that was greater than 1 cm or more.

Results

CG-0 was seen in 73 patients (28.0%), while the Champagne Glass sign was seen in 186 patients (71.3%), of whom 170 (65.1%) were CG-1 and 16 (6.1%) were CG-2 (table 2).

Conclusions

The "champagne glass sign" was often observed in the esophageal achalasia patients. "CG-0" (equal to "Maki-tsuki") was only observed in 28.0% of achalasia patients. Its absence with dilated SCJ cannot be used to rule out achalasia. We should perform an examination of barium esophagram and manometry if strongly suspected of an esophageal achalasia. This article is protected by copyright. All rights reserved.

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