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Jian H, Ming G, Shuai S, Tianyou W, Dong C. Case report of achalasia secondary to a lung carcinoma of the mediastinal type. Dis Esophagus 2016; 29:891-893. [PMID: 25833125 DOI: 10.1111/dote.12313] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Pseudo- or secondary achalasia may mimic primary achalasia upon radiological examination and may be difficult to diagnose. It is usually due to a cancer or metastases involving the gastroesophageal junction. We present the case of a 53-year-old woman with recent onset of dysphagia, and with typical findings suggesting primary achalasia. We found a 4-cm mediastinal tumor invading the lower esophagus, which was proven to be a metastasis from a lung carcinoma. The patient was treated with surgery, chemotherapy and radiotherapy. In patients with a new onset of achalasia symptoms, keeping in mind the possibility of an underlying cancer is important.
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Affiliation(s)
- Hu Jian
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Gong Ming
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Song Shuai
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wang Tianyou
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Chang Dong
- Department of Thoracic Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
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Lipka S, Katz S. Reversible pseudoachalasia in a patient with laparoscopic adjustable gastric banding. Gastroenterol Hepatol (N Y) 2013; 9:469-471. [PMID: 23935558 PMCID: PMC3736786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Seth Lipka
- Department of Medicine, Nassau University Medical Center, East Meadow, New York
| | - Seymour Katz
- North Shore University Hospital-Long Island Jewish Health System, Manhasset, New York
- St. Francis Hospital, Roslyn, New York
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Campo SMA, Lorenzetti R, de Matthaeis M, Hassan C, Zullo A, Cerro P, Morini S. Palliation with oesophageal metal stent of pseudoachalasia from gastric carcinoma at the cardia: a case report. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2009; 2009:791627. [PMID: 19746178 PMCID: PMC2738867 DOI: 10.1155/2009/791627] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Revised: 05/06/2009] [Accepted: 05/29/2009] [Indexed: 12/11/2022]
Abstract
We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.
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Affiliation(s)
| | - Roberto Lorenzetti
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
| | - Marina de Matthaeis
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
| | - Cesare Hassan
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
| | - Angelo Zullo
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
| | - Paola Cerro
- Radiology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
| | - Sergio Morini
- Gastroenterology Unit, Nuovo Regina Margherita Hospital, Via Morosini 30, 00153 Rome, Italy
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Ulla JL, Fernandez-Salgado E, Alvarez V, Ibañez A, Soto S, Carpio D, Vazquez-Sanluis J, Ledo L, Vazquez-Astray E. Pseudoachalasia of the cardia secondary to nongastrointestinal neoplasia. Dysphagia 2007; 23:122-6. [PMID: 17701248 DOI: 10.1007/s00455-007-9104-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2006] [Accepted: 05/08/2007] [Indexed: 10/23/2022]
Abstract
A minor proportion of patients with achalasia eventually have a neoplasm and, as a consequence, pseudoachalasia is diagnosed. A neoplasm may either involve gastrointestinal junction or present a paraneoplastic effect. Over the global diagnoses of achalasia issued in 5 years of experience in our motility unit, we have found 13% (3/23 cases) of pseudoachalasia (2-4% in previous series, probably due to the fact that the population assisted was mainly composed of elderly patients). The origin of the neoplasm was bladder, prostate and metastases from epidermoid carcinoma of vocal chord. Treatment of primary neoplasm, besides classical approach (with dilatation of botulinum injection) may help in the resolution of this clinical disorder.
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Affiliation(s)
- Jose Luis Ulla
- Digestive System Service, Pontevedra Hospital Complex, Pontevedra 36001, Spain.
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Gockel I, Eckardt VF, Schmitt T, Junginger T. Pseudoachalasia: a case series and analysis of the literature. Scand J Gastroenterol 2005; 40:378-85. [PMID: 16028431 DOI: 10.1080/00365520510012118] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Pseudoachalasia frequently cannot be distinguished from idiopathic achalasia by manometry, radiologic examination or endoscopy. Mechanisms proposed to explain the clinical features of pseudoachalasia include a circumferential mechanical obstruction of the distal esophagus or a malignant infiltration of inhibitory neurons within the myenteric plexus. MATERIAL AND METHODS Between January 1980 and December 2002, the clinical features of 5 patients with pseudoachalasia and 174 patients with primary achalasia, diagnosed in a single center, were compared. A literature analysis of the etiology of pseudoachalasia for the time period 1968 to December 2002 was performed. The search concentrated on the databases and online catalogues PubMed, Web of Science, Cochrane Library and Current Contents Connect. RESULTS In our case series, patients with pseudoachalasia reported a shorter duration of symptoms and tended to be older than patients with primary achalasia. Conventional manometry, endoscopy and radiologic examination of the esophagus proved to be of little value in distinguishing between the diseases. In the majority of cases only surgical exploration revealed the underlying cause. A coincidence of primary achalasia and disorders of the gastroesophageal junction was excluded by showing return of peristalsis following treatment. The analysis of the literature showed a total of 264 cases of pseudoachalasia in 122 publications. Most cases of were due to malignant disease (53.9% primary and 14.9% secondary malignancy), followed by benign lesions (12.6%) and sequelae of surgical procedures at the distal esophagus or proximal stomach (11.9%). In rare instances, the disease was an expression of a paraneoplastic process due to distant neuronal involvement rather than to local invasion with destruction of the myenteric plexus (2.6%). CONCLUSIONS The diagnosis of pseudoachalasia is difficult to establish by conventional diagnostic measures. The main distinguishing feature of secondary versus primary achalasia is the complete reversal of pathologic motor phenomena following successful therapy of the underlying disorder.
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Affiliation(s)
- Ines Gockel
- Department of General and Abdominal Surgery, Johannes Gutenberg-University Mainz, Germany.
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de Borst JM, Wagtmans MJ, Fockens P, van Lanschot JJ, West R, Boeckxstaens GE. Pseudoachalasia caused by pancreatic carcinoma. Eur J Gastroenterol Hepatol 2003; 15:825-8. [PMID: 12811315 DOI: 10.1097/01.meg.0000059141.68845.3d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Secondary achalasia or pseudoachalasia is mostly caused by gastric or oesophageal carcinoma. Here we report a case of pseudoachalasia caused by a pancreatic tumour invading the cardiac region. A 66-year-old man with a 2-month history of dysphagia and weight loss showed no abnormalities on upper gastrointestinal endoscopy and computed tomography scan, but had no swallow-induced relaxation on oesophageal manometry. Based on the patient's history and oesophageal manometry findings, further investigation was performed to exclude pseudoachalasia. Endoscopic ultrasonography showed abnormalities in the cardiac region, but large endoscopic biopsies showed no malignancy. A laparotomy was performed, which revealed a large, irresectable tumour originating from the pancreatic corpus region and expanding into the gastric cardia region. This case illustrates that a pancreatic tumour invading the cardiac region may present as pseudoachalasia.
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Affiliation(s)
- Joanneke M de Borst
- Department of Gastroenterology & Hepatology, Academic Medical Centre, Amsterdam, The Netherlands
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Mainprize KS, Dehn TC. Laparoscopic management of pseudoachalasia, esophageal diverticulum, and benign esophageal stromal tumor. Dis Esophagus 2001; 14:73-5. [PMID: 11422313 DOI: 10.1111/j.1442-2050.2001.00155.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A case report is presented of a 59-year-old woman who was suspected of having a paraesophageal hernia, but at operation was found to have an epiphrenic diverticulum of the esophagus, a benign stromal tumor of the esophagus, and pseudoachalasia. The stromal tumor was resected laparoscopically together with a laparoscopic Heller's myotomy and partial posterior fundoplication.
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Affiliation(s)
- K S Mainprize
- Department of Upper Gastrointestinal Surgery, Royal Berkshire Hospital, London Road, Reading, Berkshire, UK.
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Abstract
We report the case of a patient with a gastric remnant relapse of an antral carcinoma resected 5 years before and presenting with the clinical feature of a secondary achalasia (pseudoachalasia). In spite of the patient's 4-month history of dysphagia and weight loss that suggested a malignant lesion, barium swallow, repeated endoscopic biopsies and computed tomography (CT) scan of the upper abdomen did not reveal any abnormalities to indicate a recurrence. However, in the following months, because of worsening symptoms, a further CT scan was performed and revealed thickening of the cardia and gastric wall. The patient underwent an exploratory laparotomy that showed an unresectable lesion involving the gastric fundus, the diaphragm and penetrating into the mediastinum, and therefore a palliative jejunostomy was performed.
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Affiliation(s)
- C Iascone
- 1st Department of Surgery, Pietro Valdoni, Università La Sapienza, Policlinico Umberto I, Rome, Italy
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Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-2000. A 74-year-old man with unrelenting dysphagia. N Engl J Med 2000; 343:199-205. [PMID: 10900281 DOI: 10.1056/nejm200007203430308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Loizou LA, Grigg D, Atkinson M, Robertson C, Bown SG. A prospective comparison of laser therapy and intubation in endoscopic palliation for malignant dysphagia. Gastroenterology 1991. [PMID: 1707386 DOI: 10.1016/0016-5085(91)90782-g] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
There is little objective long-term follow-up comparing laser therapy with intubation for palliation of malignant dysphagia. In a prospective, nonrandomized two-center trial 43 patients treated with the neodymium:yttrium-aluminum-garnet laser were compared with 30 patients treated by endoscopic intubation; the two groups were comparable for mean age and tumor position, length, and histology. Dysphagia was graded from 0 to 4 (0, normal swallowing; 4, dysphagia for liquids). Pretreatment mean dysphagia grades were similar: laser-treated group, 2.9 (SD, 0.6); intubated group, 3.2 (SD, 0.55). For thoracic esophageal tumors, the percentage of patients achieving an improvement in dysphagia grade by greater than or equal to 1 grade initially and over the long term was similar (laser, 95% and 77%; intubation, 100% and 86%). For tumors crossing the cardia, intubation was significantly better (laser, 59% and 50%; intubation, 100% and 92%, respectively; P less than 0.001). In patients palliated over a long period, however, the mean dysphagia grade over the remainder of their mean dysphagia grade over the remainder of their lives (mean survival: laser, 6.1 months; intubation, 5.1 months) was better in the laser group (1.6 vs. 2.0; P less than 0.01); 33% of laser-treated and 11% of intubated patients could eat most or all solids (P less than 0.05). For long-term palliation, laser-treated patients required on average more procedures (4.6 vs. 1.4; P less than 0.05) and days in the hospital (14 vs. 9; P less than 0.05). The perforation rate was lower in the laser-treated group (2% vs. 13%; P less than 0.02); no treatment-related deaths occurred in either group. For individual patients, the best results are likely to be achieved when the two techniques are used in a complementary fashion in specialist centers.
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Affiliation(s)
- L A Loizou
- National Medical Laser Centre, University College Hospital, London, England
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