Achalasia or Pseudoachalasia: Incidental Esophagogastric Junction Submucosal Leiomyoma During Peroral Endoscopic Myotomy.

The concomitant presence of esophageal achalasia and esophagogastric junction submucosal leiomyoma is extremely rare. Peroral endoscopic myotomy has been endorsed as one of the primary interventions to manage esophageal achalasia. We present a 49-year-old woman who had initial endoscopic evaluation and diagnosis of achalasia type II then underwent peroral endoscopic myotomy and found to have incidental submucosal leiomyoma at 1 cm distal to esophagogastric junction. It was removed successfully by submucosal tunneling endoscopic resection. This poses the question of whether this is a case of achalasia or pseudoachalasia caused by leiomyoma.