Early Phase of Achalasia Manifested as an Esophageal Subepithelial Tumor
10.4166/kjg.2019.74.2.110
- Author:
Jong Hwa LEE
1
;
Young Jae LEE
;
Jong Myeong LEE
;
Myoung Jin JU
;
Min A YANG
;
Myung Woo CHOI
;
So Hee YUN
Author Information
1. Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea. rocephine@naver.com
- Publication Type:Case Report
- Keywords:
Esophagogastric junction outflow obstruction;
Esophageal achalasia;
Subepithelial tumor
- MeSH:
Classification;
Deglutition;
Esophageal Achalasia;
Esophagogastric Junction;
Esophagus;
Female;
Fundoplication;
Hernia, Hiatal;
Humans;
Hypertrophy;
Laparoscopy;
Manometry;
Middle Aged;
Peristalsis;
Protestantism;
Relaxation;
Tomography, X-Ray Computed
- From:The Korean Journal of Gastroenterology
2019;74(2):110-114
- CountryRepublic of Korea
- Language:English
-
Abstract:
The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.
