Friends of Endoscopy
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors
Search
Picture
​

Friends of Endoscopy is all about pattern recognition.  See it today and recognise it tomorrow!   Learn from a New Case on most weekdays !!! 
Become a Better Endoscopist ! 

A weird OGD

19/2/2021

 
Now this looks weird. It's a video of a gastroscopy, starting just after intubation ... 
WHAT IS THE DIAGNOSIS?
■ Achalasia
To be specific achalasia type I !
■ Large hiatus hernia
Almost difficult to tell which is oesophagus and what is stomach!
■ Reflux oesophagitis
There is reflux but no oesophagitis
■ Barrett's oesophagus
Oesophagus looks odd but is lined with squamous mucosa
■ Squamous dysplasia
The squamous mucosa is hyperkeratotic but not dysplastic
explanation
This is a patient with end-stage achalasia and a huge, 'sigmoid' oesophagus. OK, the GOJ doesn't look tight but naturally this is because the patient has in the past undergone a myotomy and fundoplication. Patients with 'Type I achalasia' presents with more severe oesophageal dilatation and less spasm-induced pain than in type II and type III achalasia. 

The silly question for the endoscopist was; 'is there anything we can do to improve swallowing'?  Of course, a more important question for the endoscopist was: 'is there any sign of cancer in the distal oesophagus?'  
After all, both SCC and adenocarcinoma may develop with a frequency of about 1:700 patient/years. Which is about half as common as cancer developing in Barrett's.  The GOJ looks a little plump and odd but biopsies did not reveal any neoplasia. Presumably the appearance was due to the previous fundoplication. 

By the way, the classification of achalasia makes no sense to me at all. This is a case of what would be called 'Type I' achalasia, which I suspect is the end stage of Type II achalasia (logically it should then be called 'Type III achalasia' shouldn't it?). The reason for the suggestion is that in 'Type II achalasia', there is still some preservation of the longitudinal muscle contraction and sufficient excitation of the circular muscle to generate intraluminal pressure but with weak forward propulsion. In type III achalasia, there is a 'nutcracker oesophagus' with a spastic gastro-oesophageal sphincter.  

Then again, perhaps the three subtypes of achalasia are three completely separate conditions? 

If you want a reminder of achalasia, here is a link to a good article! 

    Categories

    All
    Barrett's
    Cancer
    Cancer Syndromes
    Colitis
    Colorectum
    Corrosive Ingestion
    Crypt Pattern
    Difficulty: Hard
    Difficulty: Moderate
    Difficulty: Very Hard
    Duodenum
    Eosinophilic Oesophagitis
    EUS
    Foveolar Metaplasia
    Gastric
    Gastroscopy
    GI Bleeding
    Histology
    HPB
    Ileum
    Immunosuppression
    Infection
    Local Recurrence Of Barrett's Ca.
    Lymphoma
    Mixed Polyp
    Mucosal Prolapse Syndrome
    NET
    Non-lifting Sign
    Oesophagus
    Opinion Piece!
    Pharynx
    Polyp
    Polypectomy
    The Basics
    TSA

  • Home
  • Quiz Cases
  • Endoscopy Long Cases
  • Short Teaching Clips
  • Blackboard teaching
  • Podcasts
  • Core Reading
    • Basic concepts core reading
    • Gastroscopy core reading
    • Colonoscopy core reading
    • QA core reading
  • About
    • Our sponsors