Clinical presentation and evaluation of malignant pseudoachalasia

Malignant pseudoachalasia can be indistinguishable from primary achalasia o n routine clinical evaluation, often resulting in a delay in diagnosis. To better define the clinical features and appropriate management of this dise ase, the course of five patients discovered to have pseudoachalasia after b eing referred for a minimally invasive Weller myotomy was reviewed, as were 67 cases of pseudoachalasia previously reported in the literature. Patient s with an occult malignancy tended to present with shorter durations of sym ptoms, greater weight loss, and at a more advanced age than patients with p rimary achalasia. Since contrast radiography and endoscopy frequently faile d to differentiate these two diseases, persons with presumed achalasia meet ing these criteria who are referred for minimally invasive surgery should u ndergo additional imaging to rule out an occult malignancy, since this cond ition cannot: be reliably detected during the course of a thoracoscopic or laparoscopic esophagomyotomy.