title: New endoscopic indicator of esophageal achalasia: "pinstripe pattern".
abstract: OBJECTIVE
  Endoscopic diagnosis of esophageal achalasia lacking typical endoscopic features can be extremely difficult. The aim of this study was to identify simple and reliable early indicator of esophageal achalasia.
  
  
  METHODS
  This single-center retrospective study included 56 cases of esophageal achalasia without previous treatment. As a control, 60 non-achalasia subjects including reflux esophagitis and superficial esophageal cancer were also included in this study. Endoscopic findings were evaluated according to Descriptive Rules for Achalasia of the Esophagus as follows: (1) esophageal dilatation, (2) abnormal retention of liquid and/or food, (3) whitish change of the mucosal surface, (4) functional stenosis of the esophago-gastric junction, and (5) abnormal contraction. Additionally, the presence of the longitudinal superficial wrinkles of esophageal mucosa, "pinstripe pattern (PSP)" was evaluated endoscopically. Then, inter-observer diagnostic agreement was assessed for each finding.
  
  
  RESULTS
  The prevalence rates of the above-mentioned findings (1-5) were 41.1%, 41.1%, 16.1%, 94.6%, and 43.9%, respectively. PSP was observed in 60.7% of achalasia, while none of the control showed positivity for PSP. PSP was observed in 26 (62.5%) of 35 cases with shorter history < 10 years, which usually lacks typical findings such as severe esophageal dilation and tortuosity. Inter-observer agreement level was substantial for food/liquid remnant (k = 0.6861) and PSP (k = 0.6098), and was fair for abnormal contraction and white change. The accuracy, sensitivity, and specificity for achalasia were 83.8%, 64.7%, and 100%, respectively.
  
  
  CONCLUSIONS
  "Pinstripe pattern" could be a reliable indicator for early discrimination of primary esophageal achalasia.
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Hitomi
authors: H
authors: Minami
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Hajime
authors: H
authors: Isomoto
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Satoshi
authors: S
authors: Miuma
authors: Kobayashi Internal Medicine Clinic, Kobe, Japan.
authors: Yasutoshi
authors: Y
authors: Kobayashi
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Naoyuki
authors: N
authors: Yamaguchi
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Shigetoshi
authors: S
authors: Urabe
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Kayoko
authors: K
authors: Matsushima
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Yuko
authors: Y
authors: Akazawa
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Ken
authors: K
authors: Ohnita
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Fuminao
authors: F
authors: Takeshima
authors: Digestive disease center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors: Haruhiro
authors: H
authors: Inoue
authors: Department of Gastroenterology and Hepatology, Nagasaki University Hospital, Nagasaki, Japan.
authors: Kazuhiko
authors: K
authors: Nakao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004108:Dilatation, Pathologic; D004931:Esophageal Achalasia / Q000473:pathology*; D004940:Esophageal Stenosis / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult