P1878 - Not All Esophageal Webs are What They Look Like

Natali Perez-Cruz, MD, Maygret Alberro-Hernandez, MD, Paola Richiez-Nieves, MD, Maria Del Mar Burgos-Torres, MD, Esteban Grovas-Cordovi, MD, Zeyn Mirza, MD, Kathia Rosado-Orozco, MD, Jose Martin-Ortiz, MD, FACG
VA Caribbean Healthcare System, San Juan, Puerto Rico

Introduction: Esophageal dysphagia can be the result of serious medical conditions, including motility and mechanical disorders. One of the mechanical disorders is the presence of esophageal webs. These are indentations of the esophageal wall that may partially occlude the esophageal lumen. They are usually asymptomatic, but they can cause intermittent dysphagia to solids. Although found in 5 to 15% of patients undergoing upper endoscopy (EGD) for dysphagia, sometimes they are not alone. This case reflects an unusual presentation of an aggressive esophageal squamous cell carcinoma (SCC) masked by an esophageal web.

Case Description/Methods: This is the case of an 85-year-old male with history of GERD, prior alcohol use and esophageal webs reported in a prior EGD in 2016, he was consulted to the Gastroenterology service due to progressive painless dysphagia to solids with intermittent episodes of chocking and weight loss of around 20 pounds over a one-month period. He denied fever, chills, nausea, vomiting, odynophagia, or abdominal pain. The physical exam was remarkable for cachexia. Laboratories revealed anemia of chronic disease. During the hospitalization, due to persistent hypoxemia a Commuted Tomography (CT) was performed which revealed aspiration pneumonia and no pulmonary embolism, however an extensive esophageal lesion from mid to distal esophagus associated with lung involvement and possible fistulous tract between esophagus and left main bronchus was reported. An upper endoscopy was performed for further evaluation, which revealed an esophageal web in the proximal esophagus causing severe lumen narrowing, dilation of the esophageal web was performed using a balloon which allowed the insertion of a neonatal endoscope. A large friable mass extending from 23cm to 33cm of entry site was found. Biopsy results reported esophageal Squamous Cell Carcinoma (SCC). Due to an advanced disease patient opted for palliative care.

Discussion: This case emphasizes the importance of good clinical history, physical examination, and proper and extensive evaluation, especially if direct visualization with EGD is used as a method for diagnosing and treating dysphagia. Dysphagia should always be considered and alarm symptom especially in the setting of documented weight loss and history of alcohol and GERD which despite the presence of an esophageal web in prior endoscopic studies like in this case, should always place esophageal carcinoma high on the differential limiting the anchoring on prior given diagnosis.



Disclosures:


Natali Perez-Cruz, MD, Maygret Alberro-Hernandez, MD, Paola Richiez-Nieves, MD, Maria Del Mar Burgos-Torres, MD, Esteban Grovas-Cordovi, MD, Zeyn Mirza, MD, Kathia Rosado-Orozco, MD, Jose Martin-Ortiz, MD, FACG. P1878 - Not All Esophageal Webs are What They Look Like, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.