The Evaluation of Esophageal Endoscopic Findings in Patients with Functional Esophagogastric Junction Outflow Obstruction

OBJECTIVE: Esophagogastric junction outflow obstruction (EGJOO) is a diagnosis of unclear significance that has become increasingly common with recent advances in high-resolution manometry (HRM). EGJOO can be divided into mechanical or functional obstruction. Functional EGJOO is considered an incomplete phenotype or an early stage of achalasia. However, little is known about the endoscopic findings in patients with functional EGJOO. Thus, we aimed to elucidate the endoscopic findings in patients with functional EGJOO and to identify patients at high risk for achalasia. METHODS: This was a single-center retrospective study. A total of 259 patients underwent esophagogastroduodenoscopy (EGD) along with HRM for upper gastrointestinal symptoms without any obstructive lesions or stricture between July 2013 and September 2019 in our institute. Among them, 31 patients were diagnosed with EGJOO. After excluding patients who had undergone previous endoscopic treatment, those who were diagnosed with eosinophilic esophagitis and those who had undergone EGD at other institutes, 23 patients were finally included with a diagnosis of functional EGJOO. The endoscopic findings were evaluated by three endoscopists. RESULTS: Five patients (21.7%) had an esophageal rosette sign (ERS). No patients had grade IV gastroesophageal flap valve, esophageal mucosal breaks, or abnormal retention of liquid or food in the esophagus. Manometric findings revealed that the median distal contractile integral value was significantly higher in patients with an ERS (n=5) than in those without it (n=18). CONCLUSION: There were some patients with functional EGJOO who had an ERS, which is the characteristic endoscopic finding in achalasia.