Radiographic and endoscopic sensitivity in detecting lower esophageal mucosal ring.

Radiographic and endoscopic sensitivities were compared in 60 patients with lower esophageal mucosal ring. Barium esophagram detected 57 (95%) rings, all shown by the prone full-column technique. Double-contrast technique in 39 patients demonstrated only 18 (46%) rings. Endoscopy detected 35 (58%) of 60 rings. Endoscopic sensitivity depended on ring caliber with detection of 18 (82%) of 22 rings 13 mm or less in caliber, 14 (54%) of 26 14-19 mm rings, and three (25%) of 12 rings 20 mm or wider. Dysphagia was present in 13 of 25 patients with rings undetected by endoscopy. The caliber of the fiberoptic instruments used also affected endoscopic detection, with 47% of the rings being diagnosed with narrower endoscopes and 76% being diagnosed with larger instruments. Thus, the radiographic examination was more accurate in detecting lower esophageal mucosal ring and should be used initially in patients with dysphagia and suspected lower esophageal narrowing.