A previously healthy 50-year-old woman presented with a history of dysphagia and weight
loss for 5 years. A barium esophagogram revealed a dilatated esophagus (megaesophagus)
with a distal stricture. She was referred for upper endoscopy, which confirmed the
presence of megaesophagus with some liquid stasis and a distal stricture that could
not be passed with a conventional endoscope. Mucosa was normal under white-light imaging
and chromoscopy (narrow-band imaging) (A). Biopsy specimens revealed no abnormalities. A thin-caliber endoscope was then passed
to the distal part of the upper GI tract, and retroflexion revealed a concentric bulging
on the cardia, around the endoscope, with no mucosal abnormalities (B). EUS showed a thickened circular mucosal and submucosal wall (C). The elastography pattern was classified as heterogeneous soft (green), and fine-needle biopsy revealed muscular tissue with no malignancy. Hydrostatic
balloon dilation up to 20 mm was performed (D), and the patient experienced improvement in her symptoms, with a 3-kg gain in the
first month. She is scheduled to undergo repeated dilation in 1 month. Because there
were no signs of malignancy on endoscopic biopsy specimens and EUS-FNA, we believe
the diagnosis is esophageal muscular hypertrophy affecting the muscularis mucosal
layer.
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Publication history
Published online: February 09, 2021
Mohamed O. Othman, MD, Associate Editor for Focal PointsIdentification
Copyright
© 2021 by the American Society for Gastrointestinal Endoscopy
