The Application Value Of Endoscopic Ultrasonography (EUS) And Timed Barium Esophagram For Esophageal Achalasia (EA)

Part One The application value of endoscopic ultrasonography (EUS) in peroral endoscopic myotomy (POEM) for esophageal achalasia (EA)Background:To study the clinical value of endoscopic ultrasonography (EUS) before peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).Patients and methods:EUS was performed in104EA patients who were scheduled to receive POEM in order to measure the thickness of the muscularis propria layer, the circular muscle layer, and the proportion of circular muscle layer at the cardia and at positions5,10, and15cm above cardia. Another30cases who were scheduled to receive EUS for gastric lesions received additional esophageal EUS as normal controls.Results:The thickest position of the muscularis propria layer(2.73±0.92mm) and circular muscle layer(1.93±1.51mm) was at the cardia in the EA group, while the thickest position of the muscularis propria layer(2.32±0.65) and circular muscle layer(1.40±0.33mm) was at5cm above the cardia in the control group. The thickness of the circular muscle layer of the EA group was significantly greater than that of the control group at the four measure positions (p<0.05). In the EA group, the proportion of circular muscle layers was no lower than70%, but less than50%in the control group (p<0.05). In the EA group, the complication rate of POEM increased if the thickness of the muscularis propria layer was less than2mm. There was no obvious correlation between the thickness of the muscularis propria layer and the Eckardt Symptom Score before and after POEM.Conclusions:Pre-operative EUS for EA patients provides valuable information for a differential diagnosis from malignancy and for subsequent POEM. EUS may also help direct POEM surgery in some respects.Part Two:The application value of timed barium esophagram(TBE) in peroral endoscopic myotomy (POEM) for esophageal achalasia (EA)Background:To study the clinical value of timed barium oesophagram in peroral endoscopic myotomy (POEM) for esophageal achalasia (EA).Patients and methods:Timed barium oesophagram was performed in52EA patients who were scheduled to receive POEM in order to assess the oesophageal emptying.Results:There was obvious correlation between the grade of esophageal emptying and the Eckardt Symptom Score. The risk of reflux aspiration increased if the grade of esophageal emptying was Ⅲ or Ⅳ. There was no obvious correlation between the grade of esophageal emptying and the complication rate. In all patients who had accepted postoperative TBE, esophageal emptying improved.Conclusions:Timed barium esophagram for EA patients provides valuable information for a differential diagnosis from malignancy and for subsequent POEM. Timed barium esophagram may also help direct POEM surgery in some respects.