ASSESSMENT OF THE ESOPHAGEAL WALL BY ENDOSCOPIC ULTRASONOGRAPHY IN PATIENTS WITH NUTCRACKER ESOPHAGUS

Background: The correlation between the width of muscularis propria an d esophageal pressure in patients with the nutcracker esophagus is unk nown. We examined by endoscopic ultrasonography the width of the muscu laris propria in patients with nutcracker esophagus. Methods: The widt h of muscularis propria was measured at the gastroesophageal junction and at the lower, middle, and upper esophagus in 18 patients and 10 co ntrol subjects. Results: Mean muscularis propria diameter in patients was 1.8 +/- 1.4, 1.5 +/- 1.2, 1.5 +/- 0.8, and 1.2 +/- 0.4 mm at the g astroesophageal junction, lower, middle, and upper esophagus. In the c ontrol group, the mean width was 1.2 +/- 0.3, 1.2 +/- 0.3, 1.1 +/- 0.3 , and 0.9 +/- 0.1 mm, respectively. The difference was significant at the gastroesophageal junction and upper esophagus. The muscularis prop ria was wider than 3 mm in 30% of patients. There was no correlation b etween the site of the wide muscularis propria and the esophageal segm ent where high pressure was recorded. Length of disease, frequency of symptoms, and length of each symptomatic period did not correlate with the width of muscularis propria. Conclusion: The muscularis propria i s thickened in one third of patients with nutcracker esophagus. The ex tent and magnitude of this thickening do not correspond to the locatio n and the magnitude of the manometric abnormality or clinical presenta tion.