Pseudoachalasia secondary to pleural mesothelioma : laparoscopy as the key to diagnosis

Background: Pseudoachalasia due to an occult malignant tumor accounts for about 5% of patients presenting with clinical features of achalasia. Pleural mesothelioma is a rare cause of pseudoachalasia and may present without respiratory symptoms or chest pain. Methods: We present two cases of pseudoachalasia from pleural mesothelioma diagnosed by laparoscopic biopsy over a 10-year period. Results: In both patients, the onset of the disease was atypical, with dysphagia and weight loss being the predominant symptoms; no dyspnea or chest pain was reported. Prolonged (>40 years) occupational exposure to asbestos was reported only by one of the patients. Treatment was palliative and consisted of endoscopic stenting and chemotherapy. Conclusion: The diagnosis of pseudoachalasia is not always straightforward. Laparoscopy is a safe and effective method for obtaining a biopsy.