High-resolution endoluminal sonography in achalasia.

BACKGROUND: Imaging of the lower esophageal sphincter in patients with achalasia using 7.5 and 12 MHz ultrasound transducers has shown variable results. METHODS: A 20 MHz radial ultrasound transducer was used to quantitatively compare the lower esophageal sphincter in patients with achalasia to that of normal volunteers. The transducer, housed in a 6.2F catheter, was placed at the level of the lower esophageal sphincter in 29 patients with achalasia and 19 normal subjects. Videotaped images from the lower esophageal sphincter were digitized and the width of the circular smooth muscle, longitudinal smooth muscle, and total muscularis propria were measured. A mean width for each muscle layer was calculated. RESULTS: All muscle layers were found to be significantly thickened at the lower esophageal sphincter in patients with achalasia when compared with those in normal subjects: circular smooth muscle (0.206 cm +/- 0.137 cm vs 0.124 cm +/- 0.038 cm, p < 0.017); longitudinal smooth muscle (0.128 cm +/- 0.077 cm vs 0.088 cm +/- 0.028 cm, p < .041); and total muscle thickness (0.317 +/- 0.180 cm vs 0.224 cm +/- 0.049 cm, p < 0.033). CONCLUSION: Although high-resolution endoluminal sonography cannot be used to differentiate patients with achalasia from normal controls, this study quantitatively demonstrates that both the mean longitudinal and mean circular smooth muscle layers at the lower esophageal sphincter are wider in patients with achalasia than in a group of normal subjects.

Correlation of high-frequency esophageal ultrasonography and manometry in the study of esophageal motility.

BACKGROUND & AIMS: No studies correlate manometric measurements with morphological changes during the esophageal peristaltic sequence. The aim of this study was to develop and use a system for sonographically imaging the esophageal wall while simultaneously recording esophageal pressure changes. METHODS: An ultrasonography transducer attached to a manometric probe was used to evaluate the esophagus. RESULTS: Four sonographic phases of an esophageal peristaltic sequence were identified. The esophageal lumen was not open at rest in phase 1 (resting), increased to a maximum mean circumference of 4.90 +/- 0.57 cm in phase 2 (passive distention), and returned to a closed position in phases 3 (contraction) and 4 (relaxation). The muscle layers of the esophageal wall were baseline resting width in phase 1, decreased in width during phase 2, increased and reached maximum mean widths during phase 3, and returned to baseline widths during phase 4. The measurement of esophageal intraluminal pressure remained at a baseline resting level during phases 1 and 2, increased to a maximum mean peak of 67.95 +/- 9.18 mm Hg during phase 3, and returned to baseline during phase 4. CONCLUSIONS: A combined ultrasonography transducer/manometry probe was used to dynamically and simultaneously evaluate esophageal wall motion, muscle thickness, and esophageal pressure changes during peristalsis.

Less frequent causes of lower gastrointestinal bleeding.

In the United States, four diseases account for the vast majority of cases of lower intestinal bleeding: arteriovenous malformation, diverticulosis, neoplasms, and internal hemorrhoids. In this article the authors discuss less frequent causes of gastrointestinal bleeding. "Common" less frequent causes of gastrointestinal bleeding include solitary rectal ulcer syndrome, colonic varices, mesenteric vascular insufficiency, small bowel diverticula, Meckel's diverticulum, aortoenteric fistula, vasculitis, small intestinal ulceration, endometriosis, radiation-induced injury, and intussusception. Less frequent causes of gastrointestinal bleeding that have been recently described include portal colopathy, diversion colitis, and gastrointestinal bleeding in runners.

Gastric and esophageal varices: 20-MHz transnasal endoluminal US.

To image esophageal and gastric varices qualitatively and to measure esophageal varices quantitatively, 29 patients with portal hypertension underwent transnasal esophageal and gastric ultrasonography (US). Twenty-three patients underwent standard endoscopy. Endoluminal US demonstrated the varices as anechoic areas with communications in the submucosal, periesophageal, and perigastric regions, as well as ascites visualized through the gastric wall. Interobserver variation between two investigators for measurements of the largest esophageal varix in each patient was r value of .99 for diameter, r value of .99 for cross-sectional surface area, and r value of .98 for circumference. Endoscopy for evaluation of gastric varices had a sensitivity of 48% and a specificity of 50% and for evaluation of esophageal varices had a sensitivity of 94% and a specificity of 17%. Periesophageal and perigastric varices could not be visualized at endoscopy. Transnasal esophageal US, a new imaging technique with which to detect and measure esophageal varices, is a more sensitive modality than endoscopy for the detection of gastric varices.