[Malignancy on the second look - the hidden cardia carcinoma]

Dysphagia is a common disease of different aetiology. It is important to detect malignant primary diseases. Therefore, a gastroscopy including tissue samples is always indicated to rule out secondary motility disorders. The high-resolution manometry represents the gold standard in the diagnostic findings of primary motility disorders of the esophagus and reveals information about esophagogastral outflow obstructions.In the following, we present a 73-year-old patient suffering from quick progressive dysphagia and initial endoscopic inconspicuous mucosa with doubtful functional stenosis in the esophagogastric junction. Finding an esophagogastral outflow obstruction (EGJOO) in the manometry, we repeated the gastroscopy and could detect a hidden growing carcinoma of the cardia as reason for the troubles in swallowing. Our case report demonstrates that, in case of inconclusive results, a repeated endoscopic diagnostic approach, considering the manometric result, is helpful to find an explanation for dysphagia.