Brief Article
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World J Gastroenterol. Jan 28, 2013; 19(4): 556-560
Published online Jan 28, 2013. doi: 10.3748/wjg.v19.i4.556
New endoscopic classification of achalasia for selection of candidates for peroral endoscopic myotomy
Hui-Kai Li, En-Qiang Linghu
Hui-Kai Li, En-Qiang Linghu, Department of Gastroenterology, PLA General Hospital, Beijing 100853, China
Author contributions: Linghu EQ designed the research, and both authors performed the research and data analysis, and prepared the manuscript.
Correspondence to: En-Qiang Linghu, MD, Department of Gastroenterology, PLA General Hospital, Beijing 100853, China. linghuenqiang@vip.sina.com
Telephone: +86-10-66936998 Fax: +86-10-66937485
Received: August 23, 2012
Revised: October 13, 2012
Accepted: December 27, 2012
Published online: January 28, 2013
Abstract

AIM: To propose a new endoscopic classification of achalasia for selecting patients appropriate for undergoing peroral endoscopic myotomy (POEM).

METHODS: We screened out the data of patients with achalasia examined from October 2000 to September 2011 at our Digestive Endoscopic Center with endoscopic pictures clear enough to reveal the morphology of middle and lower esophagus. After analyzing the correlation between the endoscopic morphology of the esophageal lumen and POEM, we proposed a new endoscopic classification (Ling classification) of achalasia according to three kinds of endoscopically viewed structures: multi-ring structure, crescent-like structure and diverticulum structure. There were three types based on the criteria of Ling classification: type I, smooth without multi-ring, crescent-like structure or diverticulum structure; type II, with multi-ring or crescent-like structure but without diverticulum structure; and type III, with diverticulum structure. Type II was classified into three subtypes: Ling IIa, Ling IIb and Ling IIc; and type III also had three subtypes: Ling IIIl, Ling IIIr and Ling IIIlr. Two endoscopists made a final decision upon mutual agreement through discussion if their separately recorded characteristics were different.

RESULTS: Among the 976 screened patients with achalasia, 636 patients with qualified endoscopic pictures were selected for the analysis, including 405 males and 231 females. The average age was 42.7 years, ranging from 6 to 93 years. Type I was the most commonly observed type of achalasia, accounting for 64.5% (410/636), and type III was the least commonly observed type of achalasia, accounting for 2.8% (18/636). And type II accounted for 32.7% (208/636) and subtype of Ling IIa, Ling IIb and Ling IIc accounted for 14.6% (93/636), 9.9% (63/636) and 8.2% (52/636), respectively. And subtype of Ling IIIl, Ling IIIr and Ling IIIlr accounted for 0.8% (5/636), 0.3% (2/636) and 1.7% (11/636), respectively.

CONCLUSION: A new endoscopic classification of achalasia is proposed that might help in determining the proper candidates for POEM.

Keywords: Endoscopy, Classification, Achalasia, Selection, Peroral endoscopic myotomy