Endoscopic ultrasound: a new look at achalasia?

Achalasia is a relatively infrequent disorder of oesophageal motility, and is most often easily diagnosed by stationary manometry showing absence of peristalsis and incomplete lower oesophageal sphincter (LOS) relaxation. In rare cases manometric findings may be inconclusive or a malignant underlying disease is suspected. In such cases direct visualization of the LOS by endoscopic ultrasound (EUS) could contribute to securing the diagnosis and possibly lead to earlier diagnosis and treatment. With lower frequency EUS, increased thickness of the inner circular layer of the muscularis propria may be difficult to detect. Available data suggest that high frequency (20 MHz) and 3-D EUS has a potential to reliably discriminate between achalasia patients and normal subjects, and thereby be of diagnostic value.