Management of idiopathic achalasia: Short-term and long-term outcomes

Abstract

Without consensus guidelines for surveillance in patients with resected melanoma, much debate exists on the appropriate short-term and long-term management of melanoma. When discussing surveillance, it is also important to keep in mind the long-term impact of ongoing surveillance in terms of improved survival, patient quality of life, cost effectiveness, and exposure to risks associated with certain surveillance methods. Most studies recommend frequent follow-up visits with dermatologic surveillance to detect potentially curable recurrence, especially resectable locoregional recurrences. Surveillance laboratory tests and chest x-rays (CXR) can have limited value while producing a relatively high false-positive rate. Lymph node ultrasonography is a valuable imaging modality in patients with equivocal lymphatic nodal basin physical examinations. In patients with early stages of melanoma, the benefit of routine surveillance imaging studies is questionable; however, close surveillance with detailed medical history and physical examination is necessary, with special attention to regional recurrences every 3-12 months, depending on the American Joint Committee on Cancer (AJCC) stage category the patient falls into and the risk of recurrence. In Stage III or greater, more frequent surveillance in the form of more frequent physical examination , laboratory tests based on symptomatology, and cross-sectional imaging In: Cutaneous Melanoma: Etiology and Therapy. William H. Ward and Jeffrey M. Farma (Editors), Codon Publications, Brisbane, Australia. ISBN: 978-0-9944381-4-0; Doi: http://dx.doi. Licence: This open access article is licenced under Creative Commons Attribution 4.0 International (CC BY 4.0). https://creativecommons.org/licenses/by-nc/4.0/ Management of Melanoma 162 may be indicated because of the higher risk of recurrence in this population. CT, MRI, and/or PET/CT are often a component of the overall follow-up for these high-risk patients. Additional studies are needed to better define the role of surveillance in the asymptomatic patient with resected melanoma.

Meta-Analysis of Randomized and Controlled Treatment Trials for Achalasia

“…Pharmacological therapy such as calcium channel blockers is less effective and often useless [7], but can provide palliation while the patient awaits the definitive procedure or if there is clinically significant concomitant comorbidity precluding esophageal dilatation or surgery [8,9].…”

Recurrent achalasia treated with Heller myotomy: A review of the literature

“…Achalasia is a severe neuromuscular disorder of the esophagus, characterized by the loss of peristalsis and an inability of the lower esophageal sphincter (LES) to reach optimal relaxation [1] . Although the etiology of achalasia remains elusive, the mainstay of therapy is directed towards reduction of LES pressure to improve esophageal emptying by gravity [2] .…”

A systematic review and meta-analysis of the Chinese literature for the treatment of achalasia

“…Achalasia is an idiopathic primary motility disorder, characterized manometrically by poor relaxation of the lower esophageal sphincter (LES) and complete loss of primary peristalsis, which leads to a compromise in the primary function of the esophagus [1] . The cause of achalasia is not known.…”