New Endoscopic Indicator of Esophageal Achalasia: "pinstripe Pattern"

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Feb 10

PMID 25664812

Citations 19

Authors

Hitomi Minami

Hajime Isomoto

Satoshi Miuma

Yasutoshi Kobayashi

Naoyuki Yamaguchi

Shigetoshi Urabe

Kayoko Matsushima

Yuko Akazawa

Ken Ohnita

Fuminao Takeshima

Haruhiro Inoue

Kazuhiko Nakao

Affiliations

Soon will be listed here.

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.

Citing Articles

An "esophageal rosette" sign is useful for predicting favorable outcomes in peroral endoscopic myotomy for esophageal achalasia.

Higuchi K, Goto O, Kawami N, Momma E, Hoshikawa Y, Hoshino S Esophagus. 2024; 22(1):131-138.

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Toll-Like Receptor 7-Expressed Macrophages Are Involved in the Pathogenesis of Esophageal Achalasia and Esophagogastric Junction Outflow Obstruction.

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Docking Proteins Upregulate IL-1β Expression in Lower Esophageal Sphincter Muscle in Esophageal Achalasia.

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Assessment of the Physical Invasiveness of Peroral Endoscopic Myotomy during the Perioperative Period Based on Changes in Energy Metabolism.

Chinda D, Shimoyama T, Fujiwara S, Kaizuka M, Yasuda K, Akitaya K Metabolites. 2023; 13(9).

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Role of endoscopy in patients with achalasia.

Han S, Youn Y Clin Endosc. 2023; 56(5):537-545.

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References

Dellon E . Eosinophilic esophagitis. Gastroenterol Clin North Am. 2013; 42(1):133-53. PMC: 3589114. DOI: 10.1016/j.gtc.2012.11.008. View

Junginger T, Kneist W, Sultanov F, Eckardt V . [Long-term outcome of myotomy and semi-fundoplication in achalasia]. Chirurg. 2002; 73(7):704-9. DOI: 10.1007/s00104-002-0474-9. View

Howard P, Maher L, PRYDE A, Cameron E, Heading R . Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut. 1992; 33(8):1011-5. PMC: 1379432. DOI: 10.1136/gut.33.8.1011. View

Bassett J, Maydonovitch C, Perry J, Sobin L, Osgard E, Wong R . Prevalence of esophageal dysmotility in a cohort of patients with esophageal biopsies consistent with eosinophilic esophagitis. Dis Esophagus. 2009; 22(6):543-8. DOI: 10.1111/j.1442-2050.2009.00949.x. View

Loviscek L, Cenoz M, Badaloni A, Agarinakazato O . Early cancer in achalasia. Dis Esophagus. 1999; 11(4):239-47. DOI: 10.1093/dote/11.4.239. View

Inoue H, Minami H, Kobayashi Y, Sato Y, Kaga M, Suzuki M . Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010; 42(4):265-71. DOI: 10.1055/s-0029-1244080. View

Spiess A, Kahrilas P . Treating achalasia: from whalebone to laparoscope. JAMA. 1998; 280(7):638-42. DOI: 10.1001/jama.280.7.638. View

Porschen R, Molsberger G, Kuhn A, Sarbia M, Borchard F . Achalasia-associated squamous cell carcinoma of the esophagus: flow-cytometric and histological evaluation. Gastroenterology. 1995; 108(2):545-9. DOI: 10.1016/0016-5085(95)90084-5. View

West R, Hirsch D, Bartelsman J, de Borst J, Ferwerda G, Tytgat G . Long term results of pneumatic dilation in achalasia followed for more than 5 years. Am J Gastroenterol. 2002; 97(6):1346-51. DOI: 10.1111/j.1572-0241.2002.05771.x. View

10.

Dunaway P, Wong R . Achalasia. Curr Treat Options Gastroenterol. 2001; 4(1):89-100. DOI: 10.1007/s11938-001-0051-1. View

11.

Streitz Jr J, ELLIS Jr F, GIBB S, Heatley G . Achalasia and squamous cell carcinoma of the esophagus: analysis of 241 patients. Ann Thorac Surg. 1995; 59(6):1604-9. DOI: 10.1016/0003-4975(94)00997-l. View

12.

Iwakiri K, Hoshihara Y, Kawami N, Sano H, Tanaka Y, Umezawa M . The appearance of rosette-like esophageal folds ("esophageal rosette") in the lower esophagus after a deep inspiration is a characteristic endoscopic finding of primary achalasia. J Gastroenterol. 2009; 45(4):422-5. DOI: 10.1007/s00535-009-0179-7. View

13.

Eckardt V, Aignherr C, Bernhard G . Predictors of outcome in patients with achalasia treated by pneumatic dilation. Gastroenterology. 1992; 103(6):1732-8. DOI: 10.1016/0016-5085(92)91428-7. View

14.

Leeuwenburgh I, Gerrits M, Capello A, van den Bogert B, van Dekken H, Steyerberg E . Expression of p53 as predictor for the development of esophageal cancer in achalasia patients. Dis Esophagus. 2010; 23(6):506-11. DOI: 10.1111/j.1442-2050.2009.01040.x. View

15.

Leeuwenburgh I, Scholten P, Alderliesten J, Tilanus H, Looman C, Steijerberg E . Long-term esophageal cancer risk in patients with primary achalasia: a prospective study. Am J Gastroenterol. 2010; 105(10):2144-9. DOI: 10.1038/ajg.2010.263. View