Transendoscopic miniprobe and cardial stenosis

Abstract

chronic bronchitis, heartburn, type-2 diabetes mellitus, and prostatic hypertrophy presents to hospital for assessment of dysphagia to both solids and liquids. He is endoscopically diagnosed with distal esophageal stenosis with cardial-level ulceration, which suggests a reflux-related peptic lesion with negative biopsies; an initial dilation using bougies is attempted. A month later a new dilation for restenosis is performed, and further endoscopic biopsies still showed no malignity. He was admitted for severe cardial stenosis assessment. Echoendoscopy using a 12.5 MHz (2 mm in diameter, less than 30 mm in penetration) miniprobe within the distal esophagus detected a round though asymmetric, submucosal hypoechogenic mass (arrows) involving the submucosal and muscularis propria layers (linitis-type carcinoma), or the muscularis propria layer (leiomyosarcoma) with no adenopathies (Fig. 1). With this information, both a computerized tomographic (CT) scan and an endoscopy were performed. The CT scan showed a mass suggestive of distal esophageal neoplasm. Videogastroscopy demonstrated a stenotic area that did not allow the endoscope through. It was dilated using bougies 7 mm and 10.5 mm in diameter. Biopsies performed still were repeatedly negative. A surgical procedure is decided upon, and an intrathoracic esophago-gastrectomy and left lateral thoracotomy is carried out, with a diagnosis of cardial neoplasm with esophageal involvement. Pathology offered a diagnosis of intestinal-type cardial adenocarcinoma (Fig. 2) infiltrating the whole of the gastric wall and involving the submucosal, muscularis, and periesophageal fat layers. Perineural, vascular, and lymphatic involvement was extensive. Adenocarcinoma metastases were seen in 1/21 resected lymph nodes. pT3-N1-M0. Cases of tumor-related pseudoachalasia have been recently reported in our country (1,2). The authors state that “endoscopy must be the technique of choice for the early diagnosis of tumor-related pseudoachalasia in patients under assessment for suspected primary esophageal motor disorder” (3). Transendoscopic miniprobe and cardial stenosis