Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2679
Peer-review started: December 16, 2020
First decision: January 10, 2021
Revised: January 20, 2021
Accepted: February 8, 2021
Article in press: February 8, 2021
Published online: April 16, 2021
Processing time: 99 Days and 7.7 Hours
Due to a thicker abdominal wall in some patients, ultrasound artifacts from gastrointestinal gas and surrounding tissues can interfere with routine ultrasound examination, precluding its ability to display or clearly show the structure of a hernial sac (HS) and thereby diminishing diagnostic performance for esophageal hiatal hernia (EHH). Contrast-enhanced ultrasound (CEUS) imaging using an oral agent mixture allows for clear and intuitive identification of an EHH sac and dynamic observation of esophageal reflux.
In this case series, we report three patients with clinically-suspected EHH, including two females and one male with an average age of 67.3 ± 16.4 years. CEUS was administered with an oral agent mixture (microbubble-based SonoVue and gastrointestinal contrast agent) and identified a direct sign of supradiaphragmatic HS (containing the hyperechoic agent) and indirect signs [e.g., widening of esophageal hiatus, hyperechoic mixture agent continuously or intermittently reflux flowing back and forth from the stomach into the supradiaphragmatic HS, and esophagus-gastric echo ring (i.e., the “EG” ring) seen above the diaphragm]. All three cases received a definitive diagnosis of EHH by esophageal manometry and gastroscopy. Two lesions resolved upon drug treatment and one required surgery. The recurrence rate in follow-up was 0%. The data from these cases suggest that the new non-invasive examination method may greatly improve the diagnosis of EHH.
CEUS with the oral agent mixture can facilitate clear and intuitive identification of HS and dynamic observation of esophageal reflux.
Core Tip: In this research, we used a new contrast ultrasound examination method to evaluate esophageal hiatal hernia (EHH). An oral agent mixture was created by mixing microbubble-based SonoVue with a gastrointestinal contrast agent, and applied in contrast ultrasound for evaluation of EHH. This new examination method not only allowed for clear image direct visualization but also dynamic observation of esophageal reflux. To our best knowledge, this is the first report on the use of SonoVue mixed with an oral gastrointestinal contrast agent in the diagnosis of EHH.