Choi Ah Ran, Chon Nu Ri, Youn Young Hoon, Paik Hyo Chae, Kim Yon Hee, Park Hyojin
Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Clin Endosc. 2015 Jan;48(1):70-3. doi: 10.5946/ce.2015.48.1.70. Epub 2015 Jan 31.
The simultaneous occurrence of achalasia and esophageal diverticula is rare. Here, we report the case of a 68-year-old man with multiple esophageal diverticula associated with achalasia who was later diagnosed with early esophageal cancer. He initially presented with dysphagia and dyspepsia, and injection of botulinum toxin to the lower esophageal sphincter relieved his symptoms. Five years later, however, the patient presented with worsening of symptoms, and esophagogastroduodenoscopy (EGD) was performed. The endoscopic findings showed multifocal lugol-voiding lesions identified as moderate dysplasia. We decided to use photodynamic therapy to treat the multifocal dysplastic lesions. At follow-up EGD 2 months after photodynamic therapy, more lugol-voiding lesions representing a squamous cell carcinoma in situ were found. The patient ultimately underwent surgery for the treatment of recurrent esophageal multifocal neoplasia. After a follow-up period of 3 years, the patient showed a good outcome without symptoms. To manage premalignant lesions such as achalasia with esophageal diverticula, clinicians should be cautious, but have an aggressive approach regarding endoscopic surveillance.
贲门失弛缓症与食管憩室同时出现的情况较为罕见。在此，我们报告一例68岁男性病例，该患者患有与贲门失弛缓症相关的多个食管憩室，后来被诊断为早期食管癌。他最初表现为吞咽困难和消化不良，向下食管括约肌注射肉毒杆菌毒素缓解了他的症状。然而，五年后，患者症状加重，于是进行了食管胃十二指肠镜检查（EGD）。内镜检查结果显示多灶性不染碘病变，被确定为中度发育异常。我们决定采用光动力疗法治疗多灶性发育异常病变。在光动力治疗后2个月的随访EGD检查中，发现了更多代表原位鳞状细胞癌的不染碘病变。该患者最终接受了手术治疗复发性食管多灶性肿瘤。经过3年的随访期，患者预后良好，无症状。对于诸如伴有食管憩室的贲门失弛缓症等癌前病变的处理，临床医生应谨慎，但在内镜监测方面要有积极的态度。
