New endoscopic finding of esophageal achalasia with ST Hood short type: Corona appearance

• Published in: PloS one Vol. 13; no. 7; p. e0199955
• Main Authors: Shiwaku, Hironari, Yamashita, Kanefumi, Ohmiya, Toshihiro, Nimura, Satoshi, Shiwaku, Yoshiyuki, Inoue, Haruhiro, Hasegawa, Suguru
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 31-07-2018; Public Library of Science (PLoS)
• Subjects: Achalasia; Biology and Life Sciences; Care and treatment; Consistency; Contraction; Corona; Diagnosis; Diagnostic systems; Endoscopes; Endoscopy; Esophageal sphincter; Esophagus; Gastroenterology; Ischemia; Medicine; Medicine and Health Sciences; Motility; Mucosa; Pain; Patients; Positive corona; Research and Analysis Methods; Sensitivity; Sphincter; Stenosis; Surgery; Thickening; Japan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0199955

Detecting esophageal achalasia remains a challenge. We describe the diagnostic utility of corona appearance, a novel endoscopic finding specific to esophageal achalasia.
Corona appearance and seven conventional endoscopic findings were compared for sensitivity and consistency (κ-value) among 53 untreated esophageal achalasia patients who underwent endoscopy at our hospital. The following criteria had to be met during lower esophageal sphincter examination using the attached ST Hood short-type for positive corona appearance: A) congestion inside the hood, B) ischemic change around the hood, and C) palisade vessels outside the hood.
Corona appearance had the highest sensitivity (91%; κ-value, 0.71). Other findings in descending order of sensitivity included 1) functional stenosis of the esophagogastric junction (EGJ; 86%; κ-value, 0.58), 2) mucosal thickening and whitish change (71%; κ-value, 0.27), 3) abnormal contraction of the esophageal body (59%; κ-value, 0.32), 4) dilation of the esophageal lumen (58%; κ-value, 0.53), 5) liquid remnant (57%; κ-value, 0.51), 6) Wrapping around EGJ (49%; κ-value, 0.14), and 7) food remnant (30%; κ-value, 0.88). Even in 22 patients with poor (grade 1) intraluminal expansion, corona appearance had highest sensitivity (88%) compared to other endoscopic findings (κ-value, 0.63).
Among endoscopic findings using a ST Hood short-type to diagnose esophageal achalasia, corona appearance had the highest sensitivity and its consistency (κ-value) among endoscopists was substantial compared to other endoscopic findings. Similar results were obtained for esophageal achalasia cases with poor expansion. Endoscopic diagnosis of esophageal achalasia with hood attached is useful.