ENDOSCOPY VERSUS ENDOSCOPIC ULTRASONOGRAPHY IN STAGING REFLUX ESOPHAGITIS

Precise staging of reflux esophagitis is very important for therapeuti c decisions; in fact, chronic gastroesophageal reflux may cause transm ural inflammation that leads to fibrosis with loss of esophageal wall compliance. In reflux esophagitis, endoscopic staging is limited to mu cosal injury, while endoscopic ultrasonography (EUS) is able to visual ize changes in the layer structure and localized or diffuse thickening s of the esophageal wall. In order to evaluate the usefulness of EUS i n reflux esophagitis, a prospective study of 31 patients and ten norma l subjects was performed. Endoscopic reflux esophagitis was staged as: E1 (erythema, n = 7), E2 (erosions, n = 13), E3 (ulcers, n = 11). EUS findings were recorded and evaluated at five different levels, starti ng from the gastroesophageal junction, using a quantitative method, th e center line method, With this method, the sectorial and mean thickne ss, and area were calculated for each level. There was a significant d ifference between patients with reflux esophagitis and normal subjects in our study. E3 patients showed a significant upward involvement of the wail far from the visible lesions. Mild esophagitis may also cause esophageal wall thickening, involving even the entire wall. There was no correlation between the onset time of symptoms and the degree of t hickening. In conclusion, EUS seems to be an important supplement to e ndoscopy in staging reflux esophagitis, as the progression of the infl ammation is not related to the endoscopic findings.