Gomi Kuniyo, Inoue Haruhiro, Ikeda Haruo, Bechara Robert, Sato Chiaki, Ito Hiroaki, Onimaru Manabu, Kitamura Yohei, Suzuki Michitaka, Nakamura Jun, Hata Yoshitaka, Maruyama Shota, Sumi Kazuya, Takahashi Hiroshi
Digestive Disease Center, Showa University Koto-Toyosu Hospital, Tokyo, Japan.
Gastroenterology, Showa University Fujigaoka Hospital, Yokohama, Japan.
Dig Endosc. 2016 Sep;28(6):645-9. doi: 10.1111/den.12642. Epub 2016 Apr 21.
Endoscopy, barium esophagram and manometry are used in the diagnosis of achalasia. In the case of early achalasia, characteristic endoscopic findings are difficult to recognize. As a result, the diagnosis of achalasia is often made several years after symptom onset. Therefore, we examined the endoscopic findings of the cardiac orifice in achalasia and propose a new classification.
A total of 400 patients with spastic esophageal motility disorders who underwent peroral endoscopic myotomy (POEM) at our hospital between March 2014 and August 2015 were screened for this study. Champagne glass sign (CG) was defined as when the distal end of the lower esophageal sphincter relaxation failure (LESRF) was proximal to the squamocolumnar junction (SCJ) and the SCJ was dilated in the retroflex view. Specifically, CG-1 was defined as a distance from the SCJ to the lower end of LESRF of <1 cm, and CG-2 was defined as a distance ≥1 cm.
CG-0 was seen in 73 patients (28.0%), whereas the CG sign was seen in 186 patients (71.3%), of whom 170 (65.1%) were CG-1 and 16 (6.1%) were CG-2.
The CG sign is often observed in esophageal achalasia patients. CG-0 (equal to Maki-tsuki) was observed in 28.0% of achalasia patients only. Its absence with dilated SCJ cannot be used to rule out achalasia. Barium esophagram and manometry should be done if esophageal achalasia is strongly suspected.
内镜检查、食管钡餐造影和测压法用于贲门失弛缓症的诊断。在早期贲门失弛缓症病例中，特征性的内镜表现难以识别。因此，贲门失弛缓症的诊断往往在症状出现数年之后才得以做出。为此，我们研究了贲门失弛缓症患者贲门处的内镜表现，并提出一种新的分类方法。
对2014年3月至2015年8月间在我院接受经口内镜下肌切开术（POEM）的400例痉挛性食管动力障碍患者进行本研究筛选。香槟酒杯征（CG）定义为食管下括约肌松弛功能障碍（LESRF）的远端位于鳞柱状上皮交界处（SCJ）近端，且在反转视图中SCJ扩张。具体而言，CG-1定义为SCJ至LESRF下端的距离<1 cm，CG-2定义为距离≥1 cm。
73例患者（28.0%）出现CG-0，而186例患者（71.3%）出现CG征，其中170例（65.1%）为CG-1，16例（6.1%）为CG-2。
贲门失弛缓症患者常观察到CG征。仅28.0%的贲门失弛缓症患者出现CG-0（等同于牧月征）。SCJ扩张但无CG-0不能排除贲门失弛缓症。如果强烈怀疑食管贲门失弛缓症，应进行食管钡餐造影和测压检查。
