Retrospective study observes high diagnostic utility of esophagography and chest X-ray signs in esophageal achalasia, highlighting limitations of standalone endoscopy for early detection.
Key Points
To evaluate the diagnostic yield of multimodal examinations and the chest X-ray Paratracheal Air Stripe Sign (PASS) for the early detection of esophageal achalasia.
Retrospectively analyzed 215 treatment-naive patients who underwent peroral endoscopic myotomy for esophageal achalasia between 2015 and 2024 (total cohort N=281).
Assessed diagnostic yields across primary care modalities (EGD, esophagography, and CT) and evaluated the prevalence of PASS on chest radiography across achalasia subtypes.
In primary care settings, diagnostic yields were 41.1% (58/141) for EGD, 88.4% (38/43) for esophagography, and 34.8% (8/23) for CT.
The Paratracheal Air Stripe Sign on chest X-ray was identified in 67.0% (122/182) of patients overall and was present in 63.9% of patients who were not diagnosed by initial EGD.
PASS prevalence was higher in patients presenting with type I achalasia, sigmoid-type esophageal morphology, and advanced esophageal dilatation.