Endoscopic ultrasonography in the assessment of physiological cardia in esophageal achalasia

Abstract

Background. Recently, to assess the physiological cardia in esophageal achalasia (EA), the method of endoscopic ultrasonography (EUS) has been used, which combines the capabilities of two studies, endoscopic and ultrasound, in addition to traditional diagnostic methods, radiography and endoscopy, and allows detecting structural changes in the esophageal wall and lower esophageal sphincter (LES). Objective: to determine the role of endoscopic ultrasonography in assessing the state of phy­siological cardia in esophageal achalasia. Materials and methods. In the Department of Digestive Surgery of the SI “Institute of Gastroenterology of the National Academy of Medical Sciences of Ukraine” in 2023–2024, according to the objectives of the study, 15 patients with EA and 20 practically healthy individuals (control group) were examined. All patients underwent X-ray and endoscopic examination of the oesophagus, stomach, duodenum, and EUS. Results. Videoesophagogastroduodenoscopy revealed changes characteristic of EA: dilation of the esophageal diameter (100.0 %), stagnant contents in the esophageal lumen (66.7 %), resistance to the passage of an endoscope through LES (86.7 %). X-ray revealed EA stage I in 13.3 % of cases by peristalsis and esophageal diameter, stage II — in 33.3 %, stage III — in 46.7 %, and stage IV — in 6.7 % of cases. When performing EUS, the esophageal hiatus was 19.29 mm (normal 23–36 mm); the eso­phageal wall thickness in the middle third was 6.76 mm (normal < 3 mm); the LES wall thickness was 6.02 mm (normal < 5 mm). To detect fibrotic changes in the esophageal and the LES wall, compression elastography was used. This method helped reveal a significant thickening of the internal circular muscle of the LES from 2.5 to 4.5 mm in 46.6 % of cases, and in 26.6 %, with EA stage III and IV, fibrotic changes were detected in the lower third of the esophageal wall. Conclusions. It has been found that EUS in EA answers questions that are not answered by traditional research methods, namely, it makes it possible to assess a number of parameters (thickness of the walls of the LES and the lower third of the esophagus, diameter of the esophageal hiatus) and identify structural changes (the presence of fibrosis), which significantly affects the choice of a method for a surgical correction of physiological cardia in EA.