Korean J Gastroenterol.  2023 Nov;82(5):248-253. 10.4166/kjg.2023.099.

Case of Concomitant Endoscopic Treatment of Achalasia with Superficial Esophageal Cancer

• Lee MH
• Jung K
• Kim JH
• Kim SE
• Moon W
• Park MI
• Park SJ

• KMID: 2548495
• DOI: http://doi.org/10.4166/kjg.2023.099

Abstract

Achalasia, a rare motility disorder of the esophagus, is generally accepted as a premalignant disorder. This paper presents the case of a 72-year-old male with achalasia and synchronous superficial esophageal cancer who experienced dysphagia symptoms for five years. As achalasia is associated with an increased risk of esophageal cancer, both can be treated simultaneously if detected at the time of diagnosis. Achalasia and synchronous esophageal cancer are rarely detected and treated endoscopically. This paper reports a case of concurrent successful treatment.

Keyword

Achalasia; Peroral endoscopic myotomy; Esophageal cancer; Endoscopic resection

Figure

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  Fig. 1 Pre-procedure studies. (A) High-resonance manometry (HRM). HRM indicated type I achalasia owing to the absence of peristalsis, no contractile activity, and no pressurization within the esophageal body. (B) Dynamic esophageal scintigraphy showing prolongation of esophageal transit time. (C) Barium esophagography reveals a “bird-beak” appearance of the esophagogastric junction, with a dilated esophageal body and sigmoid-like appearance.

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  Fig. 2 Endoscopic findings. (A) Dilated esophagus drooping to both sides of the spine. (B) The narrowing of the distal esophagus is noted with food retention. (C) A 15 mm sized, hyperemic depressed lesion with vascular abnormality suspicious for esophageal cancer is observed 33 cm from the upper incisor. (D) Endoscopic food residue removal was performed.

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  Fig. 3 Endoscopic submucosal dissection (ESD) for esophageal superficial cancer. (A) White light image view of the lesion. (B) The narrow banding image endoscopy revealed a demarcated line, indicating the lesion margins as a brownish area. (C) The lesion was evaluated using Lugol’s solution (iodine), revealing no iodine uptake. (D) After marking and pre-cut, submucosal dissection was performed. (E) En-bloc resection was achieved, and the post-ESD scar was present on endoscopy.

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  Fig. 4 Peroral endoscopic myotomy for achalasia. (A) and (B) mucosal injections. (C) A submucosal tunnel is established. (D) The submucosa is dissected distally along the muscular layer. (E) Myotomy is performed. (F) The mucosal entry was closed with clipping.

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