Long-term outcome after laparoscopic myotomy for achalasia

Abdehgah

et al. 2019

Middle East J Dig Dis

BACKGROUND Achalasia is the most well known esophageal motility disorder. Laparoscopic Heller myotomy (LHM) is the most effective treatment for achalasia. The aim of this study was to review our results on LHM for achalasia. METHODS In this cross-sectional study all patients undergoing LHM between 2015 and 2017 were studied. The myotomy was followed by an anterior or posterior partial fundoplication. All patients were followed up for at least six months. RESULTS We conducted this prospective study on 36 consecutive patients who underwent LHM over 3 years. The mean age of the patients was 36.64 ± 13.47 years. 30 patients (83.3%) underwent Toupet and 6 patients (16.7%) received Dor fundoplication. 11 patients (30.6%) developed reflux after the procedure. According to the Eckardt Symptom Scoring (ESS), the symptoms improved in 74.2% of the patients and remained unchanged in 25.8% of the patients. Analysis of the ESS, indicated a significant change in regurgitation and retrosternal pain, dysphagia, and weight loss after the surgery (p = 0.001, p = 0.002, p = 0.046, and p = 0.001, respectively). CONCLUSION LHM with anterior or posterior partial fundoplication is safe and achieves a good outcome in the treatment of achalasia, especially in patients who have not responded to other methods while no serious complication was reported despite several prior endoscopic interventions.

Section: Discussionsupporting

confidence: 91%

Laparoscopic Heller Myotomy for Achalasia: Experience from a Single Referral Tertiary Center

Abdehgah

et al. 2019

Middle East J Dig Dis

Otolaryngol.--head neck surg.

“…Of the excluded studies, 4 reported outcomes for pediatric patients using instruments validated only in adults. 17-20…”

Section: Resultsmentioning

confidence: 99%

“…Of the excluded studies, 4 reported outcomes for pediatric patients using instruments validated only in adults. [17][18][19][20] Bergamaschi et al 21 reported on the validation of the Dysphagia in Multiple Sclerosis (DYMUS) questionnaire. This previously developed 10-item patient-completed questionnaire 22 was developed as a screening tool for dysphagia and to follow dysphagia symptoms longitudinally in patients with multiple sclerosis.…”

Section: Resultsmentioning

confidence: 99%

A Systematic Review of Patient‐ or Proxy‐Reported Validated Instruments Assessing Pediatric Dysphagia

Myer

Howell

Cohen

et al. 2016

We did not identify any validated patient- or parent-reported outcome assessment tools examining dysphagia symptoms in a general pediatric population. However, we identified 4 questionnaires that have been validated in specific pediatric disease cohorts. Having a standardized assessment instrument validated in all children would allow clinicians to systematically report symptoms and compare results of pediatric clinical trials. With this in mind, we recommend establishing a standard questionnaire for the broader pediatric population.

“…In this study, 2 out of 3 patients had complete resolution of symptoms and the third patient had improvement in symptoms after 1-year follow up [46] . Although POEM is effective, minimally invasive, and safe in adults, there is also more recent evidence to suggest that the surgical approach (laparoscopic Heller myotomy) is more definitive and long lasting in relieving symptoms in these patients compared to endoscopic dilatation or botulinum toxin injection techniques [47] . It is apparent that effective therapy for children with achalasia is needed.…”

Section: Surgicalmentioning

confidence: 99%

Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Franklin

Petrosyan

Kane

2014

WJGE

115

Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children.