Sensitivity of radionuclide bolus transport and videofluoroscopic studies compared with manometry in the detection of achalasia.

Objective: The sensitivity of radionuclide bolus transport and videofluoroscopic studies to confirm manometrically revealed achalasia was investigated prospectively in 77 patients with symptoms indicative of disordered esophageal motor function.

Methods: The studies were performed in random order and were analyzed blindly by strict diagnostic criteria. Transport of radiolabeled water was recorded for 2 min with patients supine. Videofluoroscopy assessed three swallows in prone oblique and one in upright position. Manometry employed four pressure sensors in the esophageal body and the Dent sleeve in the lower esophageal sphincter.

Results: Radionuclide and videofluoroscopic studies confirmed 25 and 15, respectively, of 37 manometrically diagnosed achalasias and provided indications for the disorder in another 8 and 16 patients. Using information from both studies increased the sensitivity to detect achalasia from 68% and 41%, respectively, to 73%, and increased detection of disordered esophageal motor function from 81% and 74% to 92%.

Conclusion: Radionuclide and videofluoroscopic studies represent valuable and complementary, although relatively insensitive, procedures to detect achalasia.