Palliation with Oesophageal Metal Stent of Pseudoachalasia from Gastric Carcinoma at the Cardia: A Case Report

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.

Budd-Chiari Syndrome and Esophageal Achalasia: Unrecognized Intrahepatic Cholangiocarcinoma Invading Multiple Organs

“…Secondary esophageal achalasia is generally believed to result from incomplete relaxation of the lower esophageal sphincter due to extra-esophageal disease, such as gastric cancer invasion or metastasis from other tumors ( 13 - 16 ). Achalasia in the present case was induced by direct invasion of the esophageal adventitia by the ICC, which was confirmed by an autopsy.…”

“…Primary esophageal achalasia results from a decrease in the number of neurons in the myenteric plexuses, while secondary esophageal achalasia results from extra-esophageal diseases, such as gastric cancer, ICC, breast cancer, or other diseases (13-16). …”

“…In contrast, esophageal achalasia is characterized by a grossly contorted and dilated esophagus due to the absence of lower esophageal sphincter relaxation ( 12 ). Primary esophageal achalasia results from a decrease in the number of neurons in the myenteric plexuses, while secondary esophageal achalasia results from extra-esophageal diseases, such as gastric cancer, ICC, breast cancer, or other diseases ( 13 - 16 ).…”

Pseudoachalasia: A review

“…[44] Advanced malignancy Palliative options have been advocated in the form of the use of metallic stent, especially in patients that are not suitable for surgery. [42,[45][46][47] Despite the initial therapeutic success, the overall results were found to be disappointing, frequent complications, such as aorta-enteric fistula, esophageal perforation, stent migration, and severe reflux esophagitis being reported. [48][49][50]…”