PROSPECTIVE COMPARISON OF TRANSCUTANEOUS SONOGRAPHY OF THE GASTROESOPHAGEAL JUNCTION WITH ENDOSCOPY

Background and objective: Despite its practical value, few data exist on assessing the gastrooesophageal junction by transcutaneous sonograp hy (TS). A prospective study was undertaken to compare TS and endoscop y (ES) of this region. Patients and methods: Between 1 September, 1994 and 31 May, 1995 TS of the lower oesophagus was followed by ES of thi s region in 211 patients (116 women, 95 men; mean age 58.9 [14-90] yea rs). None had previously been examined by ES or radiological contrast study of the oesophagus and stomach. Endoscopist and sonographer were blinded to each other's findings. The ability to visualize the abdomin al oesophagus by TS and to recognize abnormalities were compared with ES results, both quantitatively and descriptively. Results: The diaphr agmatic course of the terminal oesophagus or(where present) a gastric hernia were well visualized by TS in all 211 patients. In 78 patients with normal results on TS and ES the visible length of the oesophagus was 3.3 +/- 0.8 cm, with a wall thickness of 4.5 +/- 1.0 mm (mean +/- standard deviation). In seven of eight patients with echo-poor wall th ickness between 9 and 27 mm, suspected of being malignant, ES revealed neoplasm of the terminal oesophagus or cardia (six T2 to T4 carcinoma s; one MALT lymphoma). One patient had involvement of the oesophagus a nd cardia as part of Crohn's disease. No case of malignancy remained u nrecognized by ES. 64 of 77 hiatal hernias diagnosed by ES were also r ecognized by TS. Hiatal hernia was falsely diagnosed by TS in four pat ients. Oesophageal varices were correctly identified by TS in three of eight patients, as was one case of achalasia. Conclusion: Transcutane ous sonography is a good screening method with a high sensitivity for changes in wall architecture and it provides indications for further s elective diagnostic procedures.