Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3321-3327
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3321
Lung cancer metastasis-induced distal esophageal segmental spasm confirmed by individualized peroral endoscopic myotomy: A case report
Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Li-Lin Lin, Yan Jiang
Hong Shi, Su-Yu Chen, Zhao-Fei Xie, Li-Lin Lin, Yan Jiang, Department of Endoscopy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Branch of Fudan University Shanghai Cancer Center, Fuzhou 350014, Fujian Province, China
Co-first authors: Hong Shi and Su-Yu Chen.
Co-corresponding authors: Su-Yu Chen and Zhao-Fei Xie.
Author contributions: Shi H, Chen SY and Xie ZF were responsible for the study concept and design, including endoscopic procedures; Chen SY drafted the manuscript; Chen SY and Shi H revised and finalized the manuscript; all authors conducted the endoscopic operations together, read and approved the final manuscript.
Supported by The Young and Middle-aged Mainstay Talent Training Program of Fujian Provincial Health System, China, No. 2017-ZQN-16; The Science and Technology Project of Fujian Province, China, No. 2020Y0068; and The Joint Funds for the Innovation of Science and Technology of Fujian Province, China, No. 2023Y9414.
Informed consent statement: Informed consent was obtained from the patient for publishing his information and imaging.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest related to this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Su-Yu Chen, MD, Associate Chief Physician, Department of Endoscopy Center, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fujian Branch of Fudan University Shanghai Cancer Center, No. 420 FuMa Road, Fuzhou 350014, Fujian Province, China. endosuyuchen@163.com
Received: April 30, 2024
Revised: August 24, 2024
Accepted: September 9, 2024
Published online: October 27, 2024
Processing time: 150 Days and 18.6 Hours
Abstract
BACKGROUND

Peroral endoscopic myotomy (POEM) has been widely performed as a standard treatment for achalasia; however, its efficacy and safety for treating distal esophageal segmental spasms induced by cancer metastasis remain unknown.

CASE SUMMARY

A 72-year-old male was referred to our hospital and complained of progressive dysphagia for two years. Endoscopy revealed a 2 cm long segment esophageal stenosis with intact mucosa and normal cardia. Computed tomography showed a right upper lung mass, and pathology of the right pleural effusion confirmed the diagnosis of right upper lung adenocarcinoma with multiple rib and mediastinal lymph node metastases and right malignant pleural effusion. Individualized POEM was performed first to alleviate dysphagia, and the final diagnosis was changed to esophageal muscle metastasis arising from lung adenocarcinoma. After treatment, the patient could eat soft solid food and received multiple rounds of pembrolizumab-combination chemotherapy. The patient’s progression-free survival was approximately 16 months. Long stable disease was obtained during the 24-month follow-up.

CONCLUSION

The incidence of distal esophageal segmental spasms induced by muscular metastasis arising from lung adenocarcinoma is extremely low. Individualized POEM can effectively improve a patient’s nutritional status before subsequent chemotherapy can be combined with immune checkpoint inhibitors.

Keywords: Peroral endoscopic myotomy; Distal esophageal segmental spasm; Lung cancer; Esophageal metastasis; Case report

Core Tip: The incidence of esophageal metastasis-induced segmental spasm is extremely low. Here, we report for the first time an individualized peroral endoscopic myotomy procedure for treating distal esophageal segmental spasm caused by muscular metastasis arising from lung adenocarcinoma, and this new technique can effectively improve a patient’s nutritional status before subsequent chemotherapy combined with immune checkpoint inhibitors.