Endoscopic and histologic evaluation of advanced megaesophagus after esophagocardioplasty, vagotomy-antrectomy and roux-en-Y gastrojejunostomy (Serra Dória operation)

Morita, Shinhiti; Herani, B. F.; Coleoni, R. N.; Borin, A. A.; Santos, J S; Brienze, L. S. A.; Carvalho, Fernando Luvizotto

doi:10.1111/j.1442-2050.2005.00517.x

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…91 The patients in the study by Morita et al underwent esophagocardioplasty, vagotomy-antrectomy, and Roux-en-Y gastrojejunostomy (Serra Doria operation) for advanced megaesophagus. 92 Braghetto et al proposed an inverse Y cardioplasty + truncal vagotomy for selected cases, or a partial distal gastrectomy and Roux-en-Y gastrojejunostomy. 93 Some authors have recommended subtotal esophagectomy for sigmoid achalasia, end-stage achalasia, and surgical failure of myotomy.…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment for achalasia: when should it be performed, and for which patients?

Kashiwagi

Omura

2011

Gen Thorac Cardiovasc Surg

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Achalasia is a rare motor disorder of the esophagus, characterized by the absence of peristalsis and impaired swallow-induced relaxation. In the past decade, evidence has been accumulated suggesting that achalasia may be an immune-mediated inflammatory disorder. With the advent of minimally invasive surgery, laparoscopic Heller myotomy (LHM) has slowly shifted the treatment of achalasia toward the greater use of surgical therapy. The goal of both surgical and nonsurgical treatment is to eliminate the outflow obstruction afforded by a nonrelaxing sphincter, relieving dysphagia and maintaining a barrier against gastroesophageal reflux (GER). Endoscopic botulinum toxin injection (EBTI) is safe, easy to perform, inexpensive, and effective in aged patients, and it is especially effective when the lower esophageal pressure is hypertonic. This therapeutic option is reserved for patients too ill to undergo any surgical procedure. Pneumatic dilation (PD) has been shown to be an effective and inexpensive treatment with few adverse effects. The long-term success rate of PD seems to drop progressively over time. Heller myotomy (HM) has shown the best clinical efficacy in achalasia as a first-line treatment. Multiple endoscopic treatments are associated with poorer outcomes after HM. EBTI also makes LHM more difficult and results in a worse surgical outcome. The inferior symptomatic outcomes after thoracoscopic HM may be caused by the difficulty in extending an adequate myotomy onto the stomach from the chest and the inability to create a fundoplication. LHM with Dor's fundoplication (LHM + Dor) is effective and is safer procedure for avoiding GER, dysphagia, mucosal perforation, and a pseudodiverticulum. LHM + Dor is also effective in the presence of sigmoid achalasia, but the clinical result is not as good as nonsigmoid achalasia. A few patients need esophagectomy for surgical failure of HM. However, considering the risk of esophagectomy, LHM + Dor is the first treatment option for patients with achalasia regardless of the degree of esophageal dilatation. This procedure is therefore considered to be an effective and safe treatment for patients of any age or with any condition.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment for achalasia: when should it be performed, and for which patients?

Kashiwagi

Omura

2011

Gen Thorac Cardiovasc Surg

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“…Of the significant number of complications that patients with achalasia experience, reflux esophagitis is most important [4]. Endoscopy is used to evaluate the mucosa and identify inflammatory and neoplastic processes [5].…”

Section: Letter To the Editormentioning

confidence: 99%

Endoscopic classifications of esophageal changes in chagasic megaesophagus

Morita

Godoy

2012

Open Medicine

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AbstractThe objective of this report is to propose a classification of endoscopic changes for chagasic megaesophagus based on macroscopic findings. Thirty patients with advanced megaesophagus surgically treated using the Doria Serra technique (1968)3 were enrolled in this quasi-randomized study. All participants were treated in the Surgical Department of Hospital de Base of the Medicine School in São José do Rio Preto (FAMERP), Brazil from January 1995 to December 1999. The ages of the 17 male (56.6%) and 13 female (43.3%) patients ranged from 38 to 71 years. All participants were submitted to esophagogastroduodenal endoscopy with the following classification being proposed: mild, moderate and severe esophagitis. The current study demonstrates a correlation between the classifications of endoscopic changes and the degree of histological alterations of the esophageal mucosa in chagasic megaesophagus. Thus, this is a novel option for endoscopic evaluation of patients with this disease.

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Laparoscopic Stapled Cardioplasty—Room for Improvement

Hamer

Griffiths

Devitt

et al. 2016

Journal of Gastrointestinal Surgery

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In 2013, we described our technique for laparoscopic stapled cardioplasty for end-stage achalasia alongside promising early results. 1 Since then, our enthusiasm for this procedure has been dampened with four of five patients now having progressed to, or considering, esophagectomy.End-stage achalasia is characterised by a dilated, tortuous oesophagus, which develops into a sigmoid shape (Rezende's stage IV oesophagus). Pooling and stasis in the distal sump lead to dysphagia and regurgitation. 2 As described in the 2013 paper, laparoscopic stapled cardioplasty increases the diameter of the gastro-oesophageal junction (GEJ) and encourages the sump to empty. The initial results in three patients were excellent, with effective oesophageal emptying in all three, but two of the patients required anti-reflux medication for reflux symptoms. Subsequent to publication, a further two patients underwent a laparoscopic stapled cardioplasty, again with initially satisfactory results.Unfortunately, 3 years later and with longer follow-up, the outcomes are not encouraging, with two of the original three patients requiring an Ivor Lewis esophagectomy in 2015 for symptom control, one for regurgitation and dysphagia and the other for intractable reflux symptoms, requiring large amounts of bread to Bpush the acid down^. This particular patient's weight increased by 20 kg over a 12-month period, and esophagectomy was suggested promptly to avoid difficult surgery! The third patient of the original series has had a reasonable response to cardioplasty, although still suffering from some dysphagia and occasional food bolus obstruction at 5-year follow-up. The additional two patients are both considering esophagectomy, one for recurrent regurgitation and dysphagia 18 months following cardioplasty and the second for intractable reflux.In summary, in our small series of five patients, two have developed recurrent regurgitation and dysphagia from an enlarging sump despite widening of the GEJ, two have developed intractable reflux, and one remains relatively well.Laparoscopic stapled cardioplasty appeared compelling as an option for end-stage achalasia as the principles appeared sound (i.e., stapled division of the common wall between the stomach and dilated lower oesophagus similar to a Zenker's diverticulum), and the alternative was esophagectomy. In our hands, it has had good short-but not medium-term results, and alternatives to the described technique should be considered.Whilst it is unlikely that we can avoid recurrent regurgitation and dysphagia from a progressively enlarging sump, perhaps there is room for improvement in preventing acid reflux. Unlike a Heller's cardiomyotomy with a Dor fundoplication, the balance between allowing passage of food and preventing reflux is not consistent or predictable. It is perhaps telling that other cardioplasty procedures for mega-oesophagus (used in South America for end-stage Chagas disease) include antireflux components to the surgery. In the modified Thal procedure, 3 -5 the gastric fundus is u...

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Endoscopic and histologic evaluation of advanced megaesophagus after esophagocardioplasty, vagotomy-antrectomy and roux-en-Y gastrojejunostomy (Serra Dória operation)

Cited by 3 publications

References 20 publications

Surgical treatment for achalasia: when should it be performed, and for which patients?

Surgical treatment for achalasia: when should it be performed, and for which patients?

Endoscopic classifications of esophageal changes in chagasic megaesophagus

Laparoscopic Stapled Cardioplasty—Room for Improvement

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