BACKGROUND Pseudoachalasia mimics primary achalasia in symptoms and diagnostic findings,as observed in gastroscopy and barium swallow studies.However,pseudoachalasia,often associated with malignancies like metastatic ...BACKGROUND Pseudoachalasia mimics primary achalasia in symptoms and diagnostic findings,as observed in gastroscopy and barium swallow studies.However,pseudoachalasia,often associated with malignancies like metastatic breast cancer,requires prompt differentiation to avoid misdiagnosis and inappropriate treatment.This report highlights a rare case of pseudoachalasia secondary to metastatic breast cancer and highlights the diagnostic value of esophageal motility changes.CASE SUMMARY A 52-year-old woman presented with a one-year history of intermittent dysphagia following breast cancer surgery.Initial examinations suggested achalasia,but the patient’s high-resolution manometry(HRM)results showed a rapid shift from ineffective esophageal motility to type Ⅱ achalasia within four months.Further investigations revealed metastatic adenocarcinoma of the cardia,originating from the breast.CONCLUSION In patients with a history of malignancy,rapidly evolving esophageal motility abnormalities should raise suspicion of pseudoachalasia.HRM plays a crucial role in differentiating between primary and secondary achalasia.Early diagnosis through advanced imaging and pathology is essential for proper management.展开更多
BACKGROUND Pseudoachalasia closely mimics the clinical symptoms of idiopathic achalasia in both clinical symptoms and diagnostic findings,including those from highresolution manometry and barium esophagography.The sim...BACKGROUND Pseudoachalasia closely mimics the clinical symptoms of idiopathic achalasia in both clinical symptoms and diagnostic findings,including those from highresolution manometry and barium esophagography.The similarities often lead to misdiagnosis and the delay of appropriate treatment management.Although most malignancy-associated pseudoachalasia cases are attributed to adenocarcinoma at the gastroesophageal junction,pseudoachalasia due to esophageal squamous cell carcinoma(ESCC)should also be considered.However,the diffuse infiltrative growth patterns that can occur with ESCC can make diagnosis challenging.CASE SUMMARY We report the case of a 60-year-old man who presented with progressive dysphagia,weight loss,and nocturnal cough.Esophagogastroduodenoscopy,timed barium esophagogram,and high-resolution manometry were conducted.The results of these investigations supported a diagnosis of type Ⅱ idiopathic achalasia.However,preoperative computed tomography revealed atypical findings,which prompted further evaluation.Repeat endoscopy with magnifying narrow-band imaging identified abnormal mucosal and vascular patterns,and endoscopic ultrasound demonstrated hypoechoic submucosal lesions with involvement of the muscularis propria.Targeted biopsies confirmed moderately differentiated ESCC.Positron emission tomography revealed extensive metastatic disease;therefore,the patient was diagnosed with stage IVB ESCC.Peroral endoscopic myotomy was aborted,and the patient was referred for palliative chemoradiotherapy.CONCLUSION Atypical malignant features should be critically examined.Multimodal tools such as magnifying narrow-band imaging and endoscopic ultrasound are essential for diagnosing pseudoachalasia.展开更多
Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalas...Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalasia. Moreover, esophageal manometric findings of vascular compression at 36 cm from the nose were associated with dysphagia. An upper endoscopy showed the absence of lesions both in the esophagus and gastro-esophageal junction, whilst a 15-mm ulcer on the gastric angulus was detected. The gastric ulcer resulted in being a diffuse signet ring cell carcinoma at histology, suggesting pseudoachalasia. An abdominal computed tomography scan showed an irregular concentric thickening of the gastro-esophageal junction wall extending for 7 cm and a dilated ascending thoracic aorta with no presence of the inferior vena cava, with an enlarged azygos as the source of vascular compression of esophagus. Moreover, cardia involvement from diffuse signet ring cell carcinoma of the gastric angulus was also recognized as the cause of dysphagia. The cancer was not suitable for a surgical approach in an old patient with cardiovascular comorbidities and support therapy was started. In our ambulatory series, pseudoachalasia was eventually diagnosed in 4.7% of 234 consecutive patients with esophageal manometric finding suggestive of achalasia. We also reviewed cases in the literature and aimed to evaluate the reported causes of pseudoachalasia.展开更多
Pseudoachalasia due to pleural mesothelioma is an extremely rare condition. A 70-year-old woman presented with progressive dysphagia for solid and liquids and a mild weight loss. A barium swallow study revealed an eso...Pseudoachalasia due to pleural mesothelioma is an extremely rare condition. A 70-year-old woman presented with progressive dysphagia for solid and liquids and a mild weight loss. A barium swallow study revealed an esophageal dilatation and a smoothly narrowed esophagogastric junction. An esophageal manometry showed absence of peristalsis. Endoscopy demonstrated an extrinsic stenosis of the distal esophagus with negative biopsies. A marked thickening of the distal esophagus and a right-sided pleural effusion were evident at computed tomography （CT） scan, but cytological examination of the thoracic fluid was negative. Endoscopic ultrasound showed the disappearance of the distal esophageal wall stratification and thickening of the esophageal wall. The patient underwent an explorative laparoscopy. Biopsies of the esophageal muscle were consistent with the diagnosis of epithelioid type pleural mesothelioma. An esophageal stent was placed for palliation of dysphagia. The patient died four months after the diagnosis. This is the first reported case of pleural mesothelioma diagnosed through laparoscopy.展开更多
BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed ...BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.展开更多
文摘BACKGROUND Pseudoachalasia mimics primary achalasia in symptoms and diagnostic findings,as observed in gastroscopy and barium swallow studies.However,pseudoachalasia,often associated with malignancies like metastatic breast cancer,requires prompt differentiation to avoid misdiagnosis and inappropriate treatment.This report highlights a rare case of pseudoachalasia secondary to metastatic breast cancer and highlights the diagnostic value of esophageal motility changes.CASE SUMMARY A 52-year-old woman presented with a one-year history of intermittent dysphagia following breast cancer surgery.Initial examinations suggested achalasia,but the patient’s high-resolution manometry(HRM)results showed a rapid shift from ineffective esophageal motility to type Ⅱ achalasia within four months.Further investigations revealed metastatic adenocarcinoma of the cardia,originating from the breast.CONCLUSION In patients with a history of malignancy,rapidly evolving esophageal motility abnormalities should raise suspicion of pseudoachalasia.HRM plays a crucial role in differentiating between primary and secondary achalasia.Early diagnosis through advanced imaging and pathology is essential for proper management.
文摘BACKGROUND Pseudoachalasia closely mimics the clinical symptoms of idiopathic achalasia in both clinical symptoms and diagnostic findings,including those from highresolution manometry and barium esophagography.The similarities often lead to misdiagnosis and the delay of appropriate treatment management.Although most malignancy-associated pseudoachalasia cases are attributed to adenocarcinoma at the gastroesophageal junction,pseudoachalasia due to esophageal squamous cell carcinoma(ESCC)should also be considered.However,the diffuse infiltrative growth patterns that can occur with ESCC can make diagnosis challenging.CASE SUMMARY We report the case of a 60-year-old man who presented with progressive dysphagia,weight loss,and nocturnal cough.Esophagogastroduodenoscopy,timed barium esophagogram,and high-resolution manometry were conducted.The results of these investigations supported a diagnosis of type Ⅱ idiopathic achalasia.However,preoperative computed tomography revealed atypical findings,which prompted further evaluation.Repeat endoscopy with magnifying narrow-band imaging identified abnormal mucosal and vascular patterns,and endoscopic ultrasound demonstrated hypoechoic submucosal lesions with involvement of the muscularis propria.Targeted biopsies confirmed moderately differentiated ESCC.Positron emission tomography revealed extensive metastatic disease;therefore,the patient was diagnosed with stage IVB ESCC.Peroral endoscopic myotomy was aborted,and the patient was referred for palliative chemoradiotherapy.CONCLUSION Atypical malignant features should be critically examined.Multimodal tools such as magnifying narrow-band imaging and endoscopic ultrasound are essential for diagnosing pseudoachalasia.
文摘Pseudoachalasia is a rare secondary achalasia, which accounts for only a small subgroup of patients. We describe a 77-year-old woman with recent onset of dysphagia and typical esophageal manometric findings of achalasia. Moreover, esophageal manometric findings of vascular compression at 36 cm from the nose were associated with dysphagia. An upper endoscopy showed the absence of lesions both in the esophagus and gastro-esophageal junction, whilst a 15-mm ulcer on the gastric angulus was detected. The gastric ulcer resulted in being a diffuse signet ring cell carcinoma at histology, suggesting pseudoachalasia. An abdominal computed tomography scan showed an irregular concentric thickening of the gastro-esophageal junction wall extending for 7 cm and a dilated ascending thoracic aorta with no presence of the inferior vena cava, with an enlarged azygos as the source of vascular compression of esophagus. Moreover, cardia involvement from diffuse signet ring cell carcinoma of the gastric angulus was also recognized as the cause of dysphagia. The cancer was not suitable for a surgical approach in an old patient with cardiovascular comorbidities and support therapy was started. In our ambulatory series, pseudoachalasia was eventually diagnosed in 4.7% of 234 consecutive patients with esophageal manometric finding suggestive of achalasia. We also reviewed cases in the literature and aimed to evaluate the reported causes of pseudoachalasia.
文摘Pseudoachalasia due to pleural mesothelioma is an extremely rare condition. A 70-year-old woman presented with progressive dysphagia for solid and liquids and a mild weight loss. A barium swallow study revealed an esophageal dilatation and a smoothly narrowed esophagogastric junction. An esophageal manometry showed absence of peristalsis. Endoscopy demonstrated an extrinsic stenosis of the distal esophagus with negative biopsies. A marked thickening of the distal esophagus and a right-sided pleural effusion were evident at computed tomography （CT） scan, but cytological examination of the thoracic fluid was negative. Endoscopic ultrasound showed the disappearance of the distal esophageal wall stratification and thickening of the esophageal wall. The patient underwent an explorative laparoscopy. Biopsies of the esophageal muscle were consistent with the diagnosis of epithelioid type pleural mesothelioma. An esophageal stent was placed for palliation of dysphagia. The patient died four months after the diagnosis. This is the first reported case of pleural mesothelioma diagnosed through laparoscopy.
文摘BACKGROUND Gastric pull-up after esophagectomy is still a demanding surgical procedure and associated with considerable morbidity such as anastomotic leaks,fistulas or stenoses.These complications are usually managed by endoscopy,but in extreme cases multidisciplinary management including reoperations may be necessary.Here,we report managing therapy-refractory pseudoachalasia after Ivor Lewis esophagectomy by bypassing colonic pull-up.CASE SUMMARY A 70-year-old male with dysphagia and regurgitation after esophagectomy with gastric pull-up reconstruction was transferred to our tertiary hospital.Since endoscopic approaches including balloon dilatation and stenting failed,retrosternal colonic pull-up with Roux-en-Y reconstruction was performed with no subsequent adverse events.CONCLUSION Secondary colonic pull-up is a demanding but successful surgical procedure in patients suffering from therapy-refractory complaints after esophagectomy with gastric pull-up reconstruction.
