Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial

Rawlings, Arthur; Soper, Nathaniel J.; Oelschlager, Brant K.; Swanstrom, Lee L.; Matthews, Brent D.; Pellegrini, Carlos A.; Pierce, Richard A.; Pryor, Aurora D.; Martín, V Cabezas; Frisella, Margaret M.; Cassera, Maria A.; Brunt, L. Michael

doi:10.1007/s00464-011-1822-y

Cited by 278 publications

(135 citation statements)

References 29 publications

(39 reference statements)

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“…The preferred method has been the laparoscopic approach, or laparoscopic Heller myotomy (LHM), due to decreased morbidity and faster recovery [31,32]. Though this method effectively relieves the obstruction, it also increases the risk of gastroesophageal reflux, and most surgeons incorporate an anti-reflux procedure by way of a partial fundoplication [33,34]. Studies initially showed superiority of surgical myotomy in terms of efficiency and durability compared to single balloon dilatation [35,36].…”

Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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Background Achalasia is a rare esophageal motility disorder that is characterized by loss of peristalsis and failure of relaxation of the lower esophageal sphincter (LES), particularly during swallowing. This review focuses on the diagnosis of esophageal motility disorders as defined by the Chicago Classification ver 3.0, and presents management options with regard to per-oral endoscopic myotomy (POEM) as the treatment of choice. Methods A concise review of literature was performed for articles related to the management of achalasia, and this was contrasted with our institution's current practice. Results Achalasia is still incompletely understood, and management is focused on establishing a proper diagnosis, and relieving the obstructive symptoms. Conclusions Achalasia should be considered when dysphagia is present, and not otherwise caused by an obstruction or inflammation, and when criteria is met as per the Chicago Classification ver 3.0. Lowering LES tone and disruption of LES can be accomplished by various methods, most notably pneumatic balloon dilatation and surgical myotomy. POEM has been gaining momentum as a first line therapy for achalasia symptoms, and can be considered an important tool for motility disorders of the esophagus.

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Section: Treatmentmentioning

confidence: 99%

Current status of achalasia management: a review on diagnosis and treatment

Tuason

Inoue

2017

J Gastroenterol

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“…It should be noted that the fundoplication of Dor or Toupet performed in conjunction with a laparoscopic Heller myotomy in patients with achalasia has modest efficacy. High-quality studies of laparoscopy centers have shown that 18-42% of patients present abnormal exposure to the acid in the postoperative period, similar to that observed in the post-POEM study (13,14). It is not clear why the rate of GERD after POEM is not substantially greater than after a Heller myotomy combined with fundoplication.…”

Section: Reflux Disease (Gerd) and Poemmentioning

confidence: 86%

The impact of flexible endoscopy in esophageal surgery

et al. 2017

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Achalasia and Treatment of esophageal Adenocarcinoma are commonly associated to surgical resection. Newer technologies in interventional endoscopy gave way to a substantial paradigm shift in the management of these conditions. In the case of achalasia, endoscopic myotomy is rapidly displacing Heller's myotomy as the gold standard in many centers. Early stage neoplasia in Barrett's esophagus (BE) comprising high-grade dysplasia (HGD), intramucosal and, in some cases, submucosal carcinoma is now being treated without the need of esophagectomy. This review presents a summary of the most relevant endoscopic techniques for both achalasia and esophageal cancer. Endoscopic advances in diagnostic and therapeutic arenas allow for minimally invasive therapies and organ preservation in most settings of achalasia and early stage neoplasia of the esophagus provided that the clinical setting and physician's expertise are prepared for this approach.

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“…Hasta la fecha, solo cuatro series han presentado datos sustanciales sobre la evaluación de la ERGE en sus pacientes utilizando los tres métodos (evaluación sistemática de los síntomas, evaluación endoscópica y estudio ambulatorio de pH) 18,19 . Estos estudios hallaron que el 27-59% de los pacientes tenía signos endoscópicos de reflujo (principalmente esofagitis leve clase A o B de Los Ángeles), el 29-38% tenía anormalmente elevada la exposición al ácido en los estudios de pH y el 15-23% tenían los síntomas frecuentes de reflujo gastroesofágico 20,21 . Estos pacientes han sido tratados eficazmente con IBP.…”

Section: El Poem Y La Enfermedad Por Reflujo Gastroesofágicounclassified

Miotomía esofágica endoscópica peroral para el tratamiento de la acalasia

Nieponice¹,

Nachman²

2022

NGL

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RESUMENLa práctica de la miotomía endoscópica peroral (POEM) para el tratamiento de la acalasia ha crecido vertiginosamente en los últimos cinco años y se está transformando en la primera opción terapéutica en varios centros especializados del mundo. La presente revisión detalla los orígenes de esta opción terapéutica, sus indicaciones, la técnica, un análisis de los resultados internacionales y una reseña de la experiencia de nuestro grupo. El trabajo analiza también el reflujo posmiotomía y su comparación con la miotomía laparoscópica de Heller, que es el gran punto de debate en estos tiempos. Los resultados actuales son prometedores, demuestran su seguridad y una recuperación más rápida del paciente, lo cual apoya la adopción del POEM como primera línea de tratamiento de la acalasia en un futuro. Se requiere sin embargo contar con un equipo multidisciplinario con amplia experiencia en endoscopia terapéutica, por lo cual es aconsejable limitar este procedimiento a centros de referencia y con alto volumen en esta patología. En conclusión, la seguridad y eficacia del POEM apoyan un cambio de paradigma respecto a la miotomía laparoscópica para el tratamiento de la acalasia.

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Laparoscopic Dor versus Toupet fundoplication following Heller myotomy for achalasia: results of a multicenter, prospective, randomized-controlled trial

Cited by 278 publications

References 29 publications

Current status of achalasia management: a review on diagnosis and treatment

Current status of achalasia management: a review on diagnosis and treatment

The impact of flexible endoscopy in esophageal surgery

Miotomía esofágica endoscópica peroral para el tratamiento de la acalasia

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