The value of endoscopy and endosonography in the diagnosis of the dysphagic patient

Abstract

The value of endoscopy in dysphagia is limited in the diagnosis of motility disorders and small structures, webs, and hiatal hernias. Endoscopy is of special use for the clarification of an organic cause of dysphagia. Intraluminal tumors can be seen and in a high percentage of cases be definitely diagnosed by taking biopsies; a malignant degeneration in Barrett's esophagus is detectable by endoscopy in 89.1% of cases. Gastroesophageal reflux disease can be diagnosed on endoscopy as it leads to an endoscopically visible inflammatory reaction; however, normal findings on endoscopy cannot exclude reflux disease. Endoscopy is the method of choice in the diagnosis of nonreflux esophagitis, especially Candida and viral esophagitis. A further advantage of endoscopy is the fact that a microscopic diagnosis can be obtained and endoscopic treatment can be performed simultaneously. Submucosal or extramural lesions can be missed by endoscopy. Endosonography, the combination of endoscopy and ultrasonography (EUS) yields additional information in diagnosing submucosal and extramural lesions of the esophagus which is missed by other imaging procedures. One of the main advantages of EUS is the detection of small and submucosal lesions. The most important indication is the local staging of esophageal carcinomas; the accuracy of endosonography in determining the depth of infiltration ranges between 79% and 92%. The detection of paraesophageal lymph nodes is successful in 60%-82%, although EUS cannot differentiate benign from malignant lymph nodes. Submucosal tumors can be visualized by endosonography and their size, echopattern, and the layers of origin can be determined with high accuracy. Further indications for EUS are the exclusion of focal lesions in achalasia or peptic strictures.

Accuracy of Endoscopic Ultrasonography in Preoperative Staging of Esophageal Carcinoma

“…A meticulous preoperative assessment of all patients selected for surgical resection is desirable, more so in the light of adjuvant treatment modalities for patients with advanced stage tumors [6, 7, 8, 9, 10]. Endoscopic ultrasonography (EUS) has been shown to be an appropriate method for the preoperative staging of esophageal cancer, with high accuracy rates generally between 75 and 95% for T stage [11, 12, 13, 14, 15, 16, 17, 18, 19, 20]and 70–90% for N stage, respectively [17, 18, 21, 22, 23, 24, 25]. When compared to computed tomography (CT), EUS was found to be superior in predicting tumor depth [22, 26, 27, 28]and lymph node involvement [15, 22, 27].…”

Primary Squamous Cell Carcinoma of the Liver Initially Presenting with Pseudoachalasia

“…Pseudoachalasia may be better confirmed by EUS, which provides more definitive imaging of the extrinsic lesion and enables identification of subepithelial tumor infiltration through biopsy or cytologic brushing 11. CT scans and magnetic resonance imaging may also be useful for distinguishing the two disorders.…”

The pattern of dysphagia in children

“… 22 Endoscopy is the method of choice in the diagnosis of mucosal lesions such as esophagitis in which barium swallow is usually normal. 23 It provides not only a visual diagnosis but also histologic confirmation. The value of esophageal manometry is limited to the diagnosis of primary or secondary motility disorders and therefore it is usually indicated after negative barium swallow and endoscopy that have excluded obstruction and inflammation of the esophagus.…”