Endoscopic Tunneled Biopsy: A Novel Approach for Definitive Diagnosis of Esophagogastric Junction Adenocarcinoma Mimicking Achalasia

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Text Pseudoachalasia is a rare entity that mimics primary achalasia, often leading to significant underdiagnosis. When malignancy is suspected, achieving a definitive diagnosis becomes crucial. A 44-year-old male presented with 8-months of dysphagia and weight loss. Initial upper endoscopy and abdominal CT scan yielded normal results. High-resolution esophageal manometry revealed an IRP of 40.3 mmHg, aperistalsis and pan-pressurization, leading to the diagnosis of type II achalasia. The patient was scheduled for POEM. During the procedure, an impenetrable stenosis at the EG junction was observed. Conventional biopsy showed no tumor and PET-CT exhibited no abnormal uptake. Subsequent EUS-FNA revealed focal high-grade dysplasia. After case presentation in a multidisciplinary committee, an endoscopic tunneled biopsy was performed, confirming a well-differentiated (G1) intestinal/tubular adenocarcinoma. Video http://data.process.y-congress.com/ScientificProcess/Data//106/474/1197/070344ad-f3f6-4156-acc9-a91946f53c1c/Uploads/13821_Endoscopic_Tunneled%20Biopsy%20A%20Novel%20Approach%20for%20Definitive%20Diag....mp4 Publication History Article published online: 15 April 2024 © 2024. European Society of Gastrointestinal Endoscopy. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

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