Transabdominal Sonography of Gastroesophageal junctions
Wiwatana Tanomkiat, Asst. Prof., D. of Radiology, F. of Medicine, PSU.
Paithoon Chongchitnan, D. of Radiology, F. of Medicine, PSU.
Corresponding e-mail : twiwadha@ratree.psu.ac.th
Published : J of Clin Ultrasound 1999, 27(9) : 505-512
Key words : gastroesophageal junction, transabdominal ultrasonography
Purpose : We compared transabdominal sonography with upper gastrointestinal tract x-ray series (barium study) for evaluating gastroesophageal junction disease.
Methods : Fifty-five patients underwent barium study and sonography, which were performed independently by 2 radiologists. The results were compared. Normal findings were verified by esophagoscopy or by clinical follow-up; all abnormal findings were verified by biopsy, surgery or manometry.
Results : Findings from barium study and sonography agreed in all 30 of the normal cases. On sonography, normal gastroesophageal junctions had multiple layers of different echogenicities (mean wall thickness, 4.9 mm); the 20 cancer cases all appeared as a mass-like thickening (mean, 14.9 mm) on sonography. Barium study findings were misinterpreted as achalasia in 2 cancer cases. One benign stricture was misinterpreted as cancer by both sonography and barium study. Of the 4 cases of acha-lasia, 3 were revealed by sonography as normal gastroesophageal junctions with proximal dilatation.
Conclusion : Transabdominal sonography is useful for revealing the extramucosal component of gastroesophageal junction disease. The modality is especially useful for distinguishing between achalasia and infiltrative cancer when barium study shows smooth circumferential narrowing.
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