Diffuse Esophageal Spasm: An Alternative Treatment Approach

TL;DR

This case report describes a successful, less invasive treatment for a rare esophageal disorder in a high-risk elderly patient.

Contribution

The paper presents a successful alternative treatment approach for diffuse esophageal spasm in a high-risk patient.

Findings

Endoscopic dilation improved swallowing in a 91-year-old patient with diffuse esophageal spasm.

The patient was not a candidate for surgery due to age and comorbidities.

Pneumatic dilation provided a less invasive and effective solution for this rare condition.

Abstract

Diffuse esophageal spasm (DES) is a rare esophageal motility disorder characterized by abnormal contractions of the esophagus, leading to curling of the esophagus. The classic finding on barium swallow resembles that of the turns of a corkscrew. This case report presents a case of DES with impressive imaging and an alternative treatment approach.

There are no well-established guidelines for the treatment of DES. Treatment options include surgical myotomy, oral medications to aid in smooth muscle relaxation, esophageal dilation, and several newer approaches such as endoscopic botulinum toxin injections. There is a need for less invasive treatment modalities that provide a solution, longer than the duration of action of an oral medication in patients who are not candidates for surgical intervention. This case report presents a complex and challenging case of DES in the context of multiple complicating comorbidities. This case is unique in demonstrating the successful management of a rare esophageal motility disorder in a high-risk patient using a more traditional, less invasive treatment approach.

This case report presents a 91-year-old cachectic female with DES in the context of various comorbidities. Given her age, comorbidities, and current status, she was not a candidate for surgical intervention. After attempts at pharmacological therapy, the patient’s dysphagia continued to worsen. Upper gastrointestinal endoscopy with pneumatic esophageal dilation was performed. The patient’s swallowing improved in the days following endoscopic dilation.

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