2021 Volume 63 Issue 11 Pages 2308-2321
Endoscopy is widely performed in Japan and has made a significant contribution to the diagnosis of organic diseases. However, endoscopy is used only to rule out the diagnosis of organic diseases in cases of functional disorders. Achalasia is a major esophageal motility disorder, and recent studies have reported new endoscopic findings, including esophageal rosette, gingko-leaf sign, champagne glass sign, and pinstripe pattern in patients with achalasia. Therefore, endoscopy is increasingly being recognized as a useful diagnostic modality in cases of suspected achalasia. Endoscopic findings of spiral contractions, multiple simultaneous contractions, and esophageal narrowing with reduced distensibility may also indicate an esophageal motility disorder in patients with dysphagia. Esophageal evaluation with the endoscope fixed in the middle section of the esophagus is important for accurate diagnosis of esophageal motility disorders. High-resolution manometry (HRM) is the gold standard for the diagnosis of achalasia; however, its diagnostic accuracy is not absolute. Therefore, clinicians should consider esophageal motility disorder in patients who present with dysphagia, and comprehensive evaluation using endoscopy, esophagography, and HRM should be performed for accurate diagnosis.