Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance

Fukushima, Naoko; Masuda, Tomoyuki; Yano, Fumiaki; Omura, Nobuo; Tsuboi, Kazuto; Hoshino, Masato; Yamamoto, Se Ryung; Akimoto, Shunsuke; Sakashita, Yuki; Mitsumori, Norio; Kashiwagi, Hideyuki; Ikegami, Toru

doi:10.1007/s00464-020-08148-5

Cited by 16 publications

(14 citation statements)

References 25 publications

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“…In their study on 896 patients with a median follow-up duration of 5.2 years, Costantini et al [17] reported that LHM resulted in esophageal symptom control in 84.3% of patients over 10 years. Fukushima et al reported the success rates of LHM as 95.3%, 86.5% and 73.5% over 1, 5 and 10 years, respectively, in their study on 530 patients with a median follow-up duration of 50.5 months [18]. In our study with 70.1 months of median follow-up duration, which included 24 patients, the cumulative symptom relief rate of LHM (Eckardt ≤3) was %87.5.…”

Section: Discussionmentioning

confidence: 43%

“…Two (one of them who underwent pneumatic dilatation) of these 3 patients were consistent with JES grade I (<3.5 cm), while the other one was consistent with JES grade III. Fukushima et al reported that JES grade I patients had the highest risk of recurrent dysphagia [18]. High-resolution manometry (HRM) has recently been used in the diagnosis of achalasia.…”

Section: Discussionmentioning

confidence: 99%

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Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Sürmelioğlu¹,

Akkuş²

2021

Journal of Surgery and Medicine

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Background/Aim: Laparoscopic Heller myotomy with Dor fundoplication (LHD) is a widely used surgical method in achalasia treatment. However, it has not been well studied in terms of symptomatic relief effect and anti-reflux success in the long term. This study aimed to investigate the long-term success of LHD on symptom relief and acid reflux control. Methods: Patients who underwent LHD between February 2011 and June 2020 were included in this retrospective cohort study. Patients' demographics, post-operative follow-up outcomes and esophagitis signs on endoscopy were retrieved from the institutional database. Eckardt scores of all study patients were calculated. Those with insufficient follow-up data were excluded. Disease free rates were calculated using the Kaplan-Meier analysis. Results: A total of 24 patients, 11 males and 13 females, were included. The mean age of all patients was 47.9 (11.3) years. The median follow-up time was 71.0 (12.0-117.0) months. Cumulative symptomatic relief (Eckardt ≤3) rate of LHD was 87.5% (21/24). Kaplan-Meier analysis showed that the timedependent probability of Eckardt score being ≤3 at 3 and 5 years after the surgery were 100% and 94.7%, respectively. The mean expected survival time with Eckardt score ≤3 was 102.5 (95% CI: 87.6-117.3) months. The post-LHD esophagitis rate was 20.8% (5/24). The probability of no reflux esophagitis at 3 and 5 years after the surgery were 95.0% and 89.4%, respectively. The mean expected esophagitis-free survival was 94.2 (95% CI: 80.6-107.7) months. Conclusion: LHD seems successful and safe in terms of long-term symptomatic relief and acid reflux control in the surgical treatment of achalasia.

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Section: Discussionmentioning

confidence: 43%

Section: Discussionmentioning

confidence: 99%

Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Sürmelioğlu¹,

Akkuş²

2021

Journal of Surgery and Medicine

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“…Results showed that six patients (1.2%) developed esophageal cancer, reporting an incidence of 219.8 in 100,000 person-years. All six patients with esophageal cancer were detected early, and potentially curative resections were performed [ 9 ]. Not mentioned in the study, but may be of interest, is the incidence of high-grade dysplasia noted on endoscopy, which can be managed to reduce risk further.…”

Section: Reviewmentioning

confidence: 99%

“…Not mentioned in the study, but may be of interest, is the incidence of high-grade dysplasia noted on endoscopy, which can be managed to reduce risk further. Many recent studies have joined a support for considering routine endoscopic surveillance in achalasia patients as a tool for early detection and therefore improved prognosis in esophageal cancer and high-grade dysplasia [ 1 , 9 , 13 ]. A 2020 review article in the Annals of Esophagus (AOE) journal noting the guidelines of the ASGE and ACG brought attention to the differences in management recommendations for conditions with shared risk factors and commonly seen conditions in achalasia such as BE, where surveillance is recommended [ 31 ].…”

Section: Reviewmentioning

confidence: 99%

“…Some patients also report consequent weight loss [ 5 , 7 ]. While no definitive cure exists, highly effective palliative management offers good temporary symptom control for most patients [ 8 , 9 ]. For most, surgical treatment options are considered first-line focusing on the LES and offering dilation or a reduction in its pressure [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Surveillance in Idiopathic Achalasia

Ochuba¹,

Ruo²,

Alkayyali³

et al. 2021

Cureus

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Idiopathic achalasia is a rare esophageal dysmotility disorder of unknown etiology with only palliative treatment available. Many studies have established a significantly increased risk of esophageal cancer in patients with achalasia. However, current guidelines advise against routine surveillance due to low absolute risk and a paucity of high-quality evidence and cost-effectiveness assessments. This review aims to assess the need for routine endoscopic surveillance in achalasia based on a growing body of literature calling in support of it, mainly due to the increased risk of esophageal cancer. We searched PubMed and Google Scholar electronic databases for articles within the last 10 years using the keywords 'achalasia', 'cancer,' 'neoplasms,' 'screening,' and 'surveillance.' After excluding pseudoachalasia/secondary achalasia, other esophageal dysmotility disorders, and associations with malignancies outside the esophagus, we selected 31 articles for this review. Through these articles, we identified areas of focus for ongoing and future research that may result in significant risk reduction of complications, including esophageal cancer and beyond.

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Long‐term outcomes of treatment for achalasia: Laparoscopic Heller myotomy versus POEM

Fukushima,

Masuda,

Tsuboi

et al. 2024

Annals of Gastroent Surgery

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Achalasia is a rare esophageal motility disorder characterized by nonrelaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the gold standard treatment for achalasia. Peroral endoscopic myotomy (POEM), a less invasive treatment, is performed extensively, and the selection of the intervention method remains debatable to date. In addition to the availability of extensive studies on short‐term outcomes, recent studies on the long‐term outcomes of LHM and POEM have shown similar clinical success after 5 y of follow‐up. However, gastroesophageal reflux disease (GERD) was more common in patients who had undergone POEM than in those who had undergone LHM. Moreover, existing studies have compared treatment outcomes in various disease states. Some studies have suggested that POEM is superior to LHM for patients with type III achalasia because POEM allows for a longer myotomy. Research on treatment for sigmoid types is currently in progress. However, the long‐term results comparing LHD and POEM are insufficient, and the best treatment remains controversial. Further research is needed, and treatment options should be discussed with patients and tailored to their individual needs and pathologies.

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Over ten-year outcomes of laparoscopic Heller-myotomy with Dor-fundoplication with achalasia: single-center experience with annual endoscopic surveillance

Cited by 16 publications

References 25 publications

Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Long-term results of laparoscopic Heller myotomy with Dor-fundoplication in surgical treatment of achalasia: A single-center experience

Endoscopic Surveillance in Idiopathic Achalasia

Long‐term outcomes of treatment for achalasia: Laparoscopic Heller myotomy versus POEM

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