• 69 year old female was presented with Dysphagia to solids and weight loss of 15 kilos
  • Past medical history:- Interstitial lung disease on intermittent immune modulation
  • Blood tests:- Mild iron deficiency anaemia
  • Previous endoscopic biopsy:- Inconclusive
  • OGD Scopy:- severe esophageal candidiasis in the mid- and lower esophagus
  • Tight stricture at the lower esophageal junction.
  • The mucosa over the stricturous area appeared normal.
  • Esophagus proximal to the stricturous area appeared dilated
  • Scope could be negotiated across the stricture with difficulty
  • High Resolution Manometry: – Achalasia cardia type II
  • EUS :- performed with a blind Esophagoprobe
  • circumferential hypoechoic mass lesion was seen just proximal to the G-E junction
  • The mass appeared to invade the adventitia with loss of interface with the aorta
  • EUS guided FNA:- adenocarcinoma of the oesophagus

EXPERT COMMENTS-

  • EUS in achalasia would show hypertrophied circular muscle which is cut during Per Oral Endoscopic Myotomy
  • Type 2 achalasia is best suited for POEM treatment hence a HRM is a must before treatment
  • Mucosal biopsies do NOT exclude pseudo achalasia and EUS guided FNA is often diagnostic

TAKE HOME MESSAGE–

  • Short history and dramatic weight loss should always raise the possibility of pseudo-achalasia
  • EUS is a useful way of differentiating achalasia from pseudo achalasia
Extensive esophageal candidiasis

Extensive esophageal candidiasis

Tight Lower esophageal sphincter

Tight Lower esophageal sphincter

 

 

 

 

 

 

 

 

 

Circumferential hypo echoic mass just proximal to GE Junction

Circumferential hypo echoic mass just proximal to GE Junction

Mass invading the adventitia with loss of interface with aorta

Mass invading the adventitia with loss of interface with aorta

 

 

 

 

 

 

 

 

 

 

EUS guided FNA

EUS guided FNA

Generalised failure of peristalsis – type 2 achalasia cardia

Generalised failure of peristalsis – type 2 achalasia cardia

Comments are closed.

Post Navigation