2026 Volume 64 Issue 4 Pages 756-763
The patient was a male in his 60s who had been experiencing dysphagia, vomiting, and coughing during sleep for the past 4 years. A previous CT scan revealed esophageal dilatation, and he was referred to our hospital for further examination and treatment. CT confirmed marked esophageal dilatation, leading to suspicion of achalasia. However, esophagography and high-resolution esophageal manometry established a diagnosis of distal esophageal spasm (DES). Upper gastrointestinal endoscopy revealed a 50-mm 0-IIc lesion extending from the left to the posterior wall of the mid-thoracic esophagus, and biopsy specimens demonstrated squamous cell carcinoma (SCC). Peroral endoscopic myotomy (POEM) was performed for DES, followed by secondary endoscopic submucosal dissection (ESD) for the SCC. During POEM, the mucosal incision was carefully planned so as not to overlap with the anal side of the tumor. Postoperative esophagography revealed no barium retention, and the patient’s symptoms improved. The pathological diagnosis of the resected lesion was pT1a-LPM, ly0, v0, pHM0, and pVM0, confirming curative resection. In this case, both diseases were safely managed with minimally invasive endoscopic treatment by carefully designing the incision line. Esophageal motility disorders may be detected incidentally during medical checkups; therefore, thorough endoscopic evaluation and careful treatment planning are essential, keeping in mind the possibility of concomitant esophageal cancer.
