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Korean J Gastroenterol  <  Volume 74(2); 2019 <  Articles

Korean J Gastroenterol 2019; 74(2): 110-114  https://doi.org/10.4166/kjg.2019.74.2.110
Early Phase of Achalasia Manifested as an Esophageal Subepithelial Tumor
Jong Hwa Lee, Young Jae Lee, Jong Myeong Lee1, Myoung Jin Ju2, Min A Yang, Myung Woo Choi and So Hee Yun
Division of Gastroenterology, Departments of Internal Medicine, General Surgery1 and Pathology2, Presbyterian Medical Center, Jeonju, Korea
Correspondence to: So Hee Yun, Division of Gastroenterology, Department of Internal Medicine, Presbyterian Medical Center, 365 Seowon-ro, Wansan-gu, Jeonju 54987, Korea. Tel: +82-63-230-1310, Fax: +82-63-230-1329, E-mail: rocephine@naver.com, ORCID: https://orcid.org/0000-0003-4757-846X

Financial support: This study was supported by a grant from Presbyterian Medical center in 2018.
Received: February 1, 2019; Revised: May 16, 2019; Accepted: May 17, 2019; Published online: August 25, 2019.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
The Chicago classification (CC) defines an esophagogastric junction outflow obstruction (EGJOO) as the presence of several instances of intact or weak peristalsis, elevated median integrated relaxation pressure above 15 mmHg, and a discrepancy from the criteria of achalasia. The revised CC addresses the potential etiology of EGJOO, including the early forms of achalasia, mechanical obstruction, esophageal wall stiffness, or manifestation of hiatal hernia. A 58-year-old woman visited the Presbyterian Medical Center with swallowing difficulty. The patient underwent a high resolution manometry (HRM) examination and was diagnosed with EGJOO. Chest CT was performed to exclude a mechanical obstruction as a cause, and CT revealed a subepithelial tumor (SET) at the upper part of the esophagogastric junction. Therefore, laparoscopic surgery was performed and eccentric muscular hypertrophy of the distal esophagus was observed. Longitudinal myotomy and Dor fundoplication were also performed. The histology findings of the surgical specimens were consistent with achalasia. This paper reports a case of early achalasia that was finally diagnosed by the histology findings, but was initially diagnosed as EGJOO using HRM and misdiagnosed as SET in the image study.
Keywords: Esophagogastric junction outflow obstruction; Esophageal achalasia; Subepithelial tumor


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