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

Area of Science:

• Gastroenterology
• Esophageal Motility Disorders
• Diagnostic Imaging

Background:

• Dysphagia is a common symptom with diverse causes.
• Malignant conditions must be excluded early in dysphagia evaluation.
• Esophageal motility disorders can cause significant swallowing impairment.

Purpose of the Study:

• To highlight the importance of high-resolution manometry (HRM) in diagnosing esophageal motility disorders.
• To present a case where repeated gastroscopy, guided by manometry, revealed a hidden malignancy.
• To emphasize the diagnostic value of integrating manometry with endoscopy for complex dysphagia.

Main Methods:

• High-resolution manometry (HRM) to assess esophageal and esophagogastric junction (EGJ) pressures.
• Gastroscopy with tissue sampling to evaluate mucosal integrity.
• Repeated gastroscopy following manometric findings of esophagogastric outflow obstruction (EGJOO).

Main Results:

• Manometry identified an esophagogastric outflow obstruction (EGJOO).
• Initial gastroscopy showed inconspicuous mucosa with a doubtful functional stenosis.
• A subsequent gastroscopy revealed a hidden carcinoma of the cardia.

Conclusions:

• High-resolution manometry is essential for diagnosing primary esophageal motility disorders and EGJOO.
• In cases of inconclusive initial endoscopy, a repeated endoscopic approach informed by manometric results is vital.
• This case underscores the necessity of a comprehensive diagnostic strategy for unexplained dysphagia to uncover underlying malignancies.