Sa1321 VALUE OF ENDOSCOPY ULTRASONOGRAPHY IN THE TREATMENT OF DIFFUSE ESOPHAGEAL SPASM WITH PERORAL ENDOSCOPIC MYOTOMY

Abstract

Diffuse esophageal spasm (DES) is a rare esophageal motility disorder of normal amplitude and accompanied by dysphagia. It is characterized by simultaneous, uncoordinated or rapidly propagated contractions. The etiology of DES is unknown. There are various theories proposed. Muscular hypertrophy or hyperplasia is present in the distal part of the esophagus comprising almost two-thirds of the esophagus in DES. High-resolution manometry (HRM) and esophageal pressure topography (EPT) is valuable for the diagnosis .These also be used to determine the length of myotomy preoperatively which is not very exact. Now, extended myotomy of the esophageal body or peroral endoscopic myotomy(POEM) is accepted to treat DES. How to determine the entire length of myotomy is important which needs including all the affected segment and extend several centimeters superior to the proximal border of the spastic region to prevent remnants of spasticity. Using high resolution 20 MHz small ultrasonic probe to detect the thickness of esophageal muscle layer from the upper and lower parts of the obvious spasm ring under endoscope. Recording the beginning position and region where the thickness of myometrium thickening. The thickness is obviously thicker than normal esophageal. The length of thickening region is different. The length of myotomy is determined preoperatively with ultrosound. Using a electric knife to cut the circular muscle from the begining of thickness to 2 centimeters below the cardia. The thickness of muscle layer is segmental thickening while common esopheal only 3 millimeters,The length of myotomy is different from 10 to 17centimeters. So,Using endoscopy ultrasonography to judge both the initial position and length of myotomy is valuable. And this can accelerate the accuracy of POEM procedure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)