Megaoesophagus and Esophageal Cancer

Abstract

Review ArticleAchalasia or megaesophagus is a pathology predisposing to the occurrence of squamous cell carcinoma and adenocarcinoma of the esophagus. The diagnosis is often made late. The first-line paraclinical workup should include esogastroduodenal fibroscopy with biopsies to confirm the diagnosis. Materials and methods: Retrospective study over a period of 18 years collecting all the patients followed in our departement. The diagnosis of megaesophagus was made by esophageal manometry. Results: Among 104 patients followed for megaesophagus, only one patient developed an squamous cell carcinoma on achalasia, that is a prevalence of 0.96%. This is a 44-year-old patient who is non smoker, or who consumes alcohol and who has had functional dysphagia since the age of 5 and in whom esophageal manometry had demonstrated an aperistalsis of the esophageal body with hypertonia and lack of relaxation of the LES. This dysphagia became 39 years later marked with solids and semi-liquids, a constant progressive associated with odynophagia and weight loss of 07 kg in 2 months.The clinical examination was without particularities. Esogastroduodenal fibroscopy objectified ulcerative stenosing cauliflower mass of the lower esophagus. The anatomopathological study of the biopsies revealed a well differentiated, mature and infiltrating squamous cell carcinoma of the lower esophagus. A thoraco-abdomino-pelvic CT scan revealed a tumor of the lower stenosing esophagus classified T3N0M0. The patient received exclusive radiochemotherapy. Conclusion: The megaesophagus is a risk factor for the development of squamous cell carcinoma of the esophagus. The prevalence in our series is 0.6% of cases. The clinician must be aware of this association so that prevention programs and treatment are not delayed.