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Classic Endoscopic Findings of Achalasia

Endoscopy plays an important role in early evaluation, primarily to exclude other diseases such as webs, rings, esophageal cancer, and proximal gastric cancer, which can mimic the symptoms of achalasia. The most common cause of secondary achalasia is malignancy, which accounts for more than half of all cases, followed by benign lesions and sequelae of surgical procedures. The classic endoscopic findings of achalasia include retained saliva with a puckered EGJ, widening of the esophageal lumen, and food residue in the esophagus. The descriptive rules for achalasia of the esophagus, established by the Japan Esophageal Society present the diagnostic features of achalasia on endoscopy as follows: (1) dilatation of the esophageal lumen; (2) abnormal retention of food and/or liquid remnants in the esophagus; (3) whitish change and thickening of the esophageal mucosal surface; (4) functional stenosis of the EGJ, in which the endoscope passes through the stenotic segment and the EGJ fails to dilate by insufflation; and (5) abnormal contraction waves of the esophagus.