P1.008. Diagnostic Value of Multimodal Examinations and the Paratracheal Air Stripe Sign for Detecting Esophageal Achalasia

Topic Benign Disease: Esophageal Function and Motility Background Esophageal achalasia increases the risk of esophageal cancer in long-standing disease, making early detection important. Although typical esophagogastroduodenoscopy (EGD) findings include esophageal dilatation and the rosette sign, diagnosis based on EGD alone can be challenging. This study evaluated the diagnostic value of multiple examinations for early detection of esophageal achalasia. Methods Among 281 patients who underwent peroral endoscopic myotomy for esophageal achalasia at our institution between 2015 and 2024, 215 patients without prior treatment were retrospectively analyzed. Clinical pathways to the final diagnosis were reviewed, and the diagnostic yield of each modality was assessed. In addition, the impact of achalasia subtype on the diagnostic performance of each examination was analyzed. Results The median age at treatment was 58 years (range, 9–89), and the median symptom duration was 35 months (range, 0–593). In primary care facilities, the diagnostic yields were 41.1% (58/141) for EGD, 88.4% (38/43) for esophagography, and 34.8% (8/23) for computed tomography (CT), indicating that the diagnostic yield of EGD alone was relatively low. Retrospective review of chest X-rays identified a characteristic finding suggestive of esophageal achalasia, termed the Paratracheal Air Stripe Sign (PASS), in 67.0% (122/182) of patients. A higher prevalence of this sign was noted in patients with type I achalasia, sigmoid-type esophageal morphology, and advanced esophageal dilatation. Importantly, PASS was present in 63.9% of patients in whom achalasia had not been diagnosed by EGD. Conclusion The diagnostic yield of EGD alone for esophageal achalasia was suboptimal. In patients presenting with symptoms suggestive of achalasia, combining EGD with esophagography may facilitate earlier diagnosis. In addition, a characteristic finding was observed on chest X-ray in a subset of patients. Given the wide availability of chest X-ray, even in primary care facilities, PASS may serve as a supportive indicator for the detection of esophageal achalasia.