Can Esophageal Stıffness and Thıckness Measurement By Transcervıcal Sonoelastography Predıct Reflux Esophagıtıs?

OBJECTIVE: We aimed to investigate the efficacy of transcervical esophageal sonoelastography in discriminating between patients with and without Reflux Esophagitis (RE). METHODS: Patients who underwent an esophagogastroduodenoscopy following a transcervical sonoelastographic examination in a tertiary center were included. The thickness and Shear Wave Velocity (SWV) of the submucosa-mucosa, muscularis mucosae, and total esophageal wall were measured by using sonoelastography. Patients were classified into RE-positive (grades A-D according to The Los Angeles Classification) and REnegative groups based on endoscopic findings. The elastosonographic features of RE (-) and RE (+) patients were compared statistically Results: Among the 503 included patients, 129 (25.6%) were RE (+) [(80 grade A (62%), 28 grade B (21.7%), 12 grade C (9.3%), 9 grade D (7%)] and 374 were RE (-). A 31.7% positive correlation between age and Total Wall Thickness (TWT) and a 21% negative correlation between TWT and submucosa-mucosa SWV were detected. The thickness of submucosa-mucosa, muscularis propria, and total wall were significantly higher in RE (+) patients compared to RE (-) patients (p < 0.001 for all). The SWVs of submucosa-mucosa, muscularis propria, and total wall were significantly lower in RE (+) patients compared to RE (-) patients (p < 0.001 for all). A cut-off value of 2.35 mm for TWT yielded 67% sensitivity and 57% specificity, while a cut-off of 2.08 m/s for total wall SWV yielded 79% sensitivity and 81% specificity for the diagnosis of RE. DISCUSSION: The significant increase in cervical esophageal wall thickness in RE (+) is consistent with the literature. However, the markedly decreased stiffness is a novel finding demonstrated by this study. CONCLUSION: The evaluation of esophageal thickness and stiffness using sonoelastography may be added to routine neck ultrasound scans for the prediction of RE.