Martins MCL, Miyazaki DM, Gabiattiet CCT, et al. - Given that esophageal carcinoma develop in nearly 4% to 10% of patients diagnosed with Chagas-induced megaesophagus disease, researchers sought for the natural history and clinical pattern of this entity. Among 593 patients with esophageal carcinoma treated at a single Brazilian institution, there were 32 patients with Chagas disease, of whom 11 had megaesophagus. Despite the similarity in the three groups regarding baseline characteristics, a lower rate of smoking was present in patients with Chagas megaesophagus–associated carcinoma (CMAC). This factor strengthened the concept of the predominant risk of cancer development in correlation with achalasia. They observed a higher rate of tumor in situ in the CMAC group (two of 11 patients) vs the other groups. Treatment comprised endoscopic resection for these patients with no identified recurrence. Locally advanced disease was observed in eight of 11 patients with CMAC. Findings revealed a dismal prognosis in the absence of prompt detection of CMAC. This indicates the necessity for a high index of suspicion of esophageal carcinoma for patients with Chagasic megaesophagus.