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

Background and Study Aims: Detecting esophageal achalasia remains a challenge. We describe the diagnostic utility of corona appearance, a novel endoscopic finding specific to esophageal achalasia.

Patients and Methods: Corona appearance and seven conventional endoscopic findings were compared for sensitivity and consistency (-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.

Results: Corona appearance had the highest sensitivity (91%; -value, 0.71). Other findings in descending order of sensitivity included 1) functional stenosis of the esophagogastric junction (EGJ; 86%; -value, 0.58), 2) mucosal thickening and whitish change (71%; -value, 0.27), 3) abnormal contraction of...

背景与研究目的：食管贲门失弛缓症（esophageal achalasia）的临床诊断仍存在挑战。本研究旨在阐明冠状外观（corona appearance）——一种针对食管贲门失弛缓症的新型内镜下征象——的诊断应用价值。

患者与方法：本研究纳入53例于我院接受内镜检查且未接受过治疗的食管贲门失弛缓症患者，对比冠状外观与7种常规内镜下征象的诊断灵敏度及一致性（科恩kappa值，κ-value）。使用配套ST Hood短型内镜行食管下括约肌检查时，冠状外观阳性需满足以下三项标准：A）镜鞘内充血；B）镜鞘周围缺血改变；C）镜鞘外栅栏状血管。

结果：冠状外观的诊断灵敏度最高（91%；κ-value=0.71）。其余征象按灵敏度从高到低依次为：1）食管胃接合部（esophagogastric junction, EGJ）功能性狭窄（86%；κ-value=0.58）；2）黏膜增厚伴发白改变（71%；κ-value=0.27）；3）异常收缩……