Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata, Japan.
Neurogastroenterol Motil. 2018 Jan;30(1). doi: 10.1111/nmo.13168. Epub 2017 Jul 26.
Previously, the mucosal histology in achalasia has only been investigated using superficial biopsy or surgically resected esophageal specimens in end-stage cases. We investigated the histology of the full-layer mucosa in early and advanced achalasia.
Endoscopy was performed for the pinstripe pattern (PSP) (an early achalasia indicator) and dilation and thickening of the mucosa (advanced achalasia indicators). A mucosal entry site for peroral endoscopic myotomy was created using cap-fitted endoscopic mucosal resection to access the full-layer mucosa and the submucosa.
Mucosal histology was compared between 32 patients with achalasia and 15 controls. Histological esophagitis with findings of inflammatory cell infiltration and dilated intercellular spaces was observed more in patients with achalasia than in controls (87.5% vs 13.3%, P<.001; 84.4% vs 46.7%, P=.049). Muscularis mucosae (MM) atrophy and epithelial wave were only observed in achalasia (40.6% vs 0%, P=.005; 28.1% vs 0%, P=.043). Fibrosis was more common in achalasia, but without statistical significance (31.3% vs 20.0%, P=.503). In achalasia with endoscopic dilation and thickening of the mucosa, MM atrophy was observed histologically, and in cases involving endoscopic PSP, the histological epithelial wave was observed.
CONCLUSIONS & INFERENCES: Histological findings of esophagitis were observed endoscopically even in early achalasia. Pinstripe pattern corresponds to the epithelial wave observed histologically in achalasia, whereas endoscopic findings in advanced achalasia correspond to MM atrophy. Appropriate management is necessary during early achalasia to prevent progression to advanced achalasia with more severe histological changes.
以前，只有在食管终末期病例中通过浅表活检或手术切除的食管标本来研究贲门失弛缓症的黏膜组织学。我们研究了早期和晚期贲门失弛缓症的全层黏膜组织学。
通过针状条纹图案（PSP）（早期贲门失弛缓症的指标）和黏膜扩张增厚进行内镜检查（晚期贲门失弛缓症的指标）。使用带帽内镜黏膜切除术（EMR）创建黏膜进入口，以获取全层黏膜和黏膜下层。
将 32 例贲门失弛缓症患者和 15 例对照者的黏膜组织学进行比较。与对照组相比，贲门失弛缓症患者的黏膜组织学中更常见食管炎表现，包括炎症细胞浸润和扩张的细胞间隙（87.5% vs 13.3%，P<.001；84.4% vs 46.7%，P=.049）。只有在贲门失弛缓症中观察到黏膜肌层（MM）萎缩和上皮波（40.6% vs 0%，P=.005；28.1% vs 0%，P=.043）。纤维化在贲门失弛缓症中更常见，但无统计学意义（31.3% vs 20.0%，P=.503）。在伴有内镜下黏膜扩张和增厚的贲门失弛缓症中，观察到 MM 萎缩的组织学表现，而在伴有内镜 PSP 的病例中，观察到上皮波的组织学表现。
即使在早期贲门失弛缓症中，也可通过内镜观察到食管炎的组织学表现。针状条纹图案与贲门失弛缓症中观察到的上皮波相对应，而晚期贲门失弛缓症的内镜表现则与 MM 萎缩相对应。在早期贲门失弛缓症中需要进行适当的治疗，以防止进展为更严重的组织学变化的晚期贲门失弛缓症。
