Pneumatic Dilatation or Laparoscopic Cardiomyotomy in the Management of Newly Diagnosed Idiopathic Achalasia

Kostic, Srdjan; Kjellin, Ann; Ruth, Magnus; Lönroth, Hans; Johnsson, Erik L.; Andersson, Mats; Lundell, Lars

doi:10.1007/s00268-006-0600-9

Cited by 137 publications

(111 citation statements)

References 71 publications

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“…Some studies showed a superiority of the surgery procedure in controlling symptoms and in symtopm-free duration, (68). In line with these data, a romanian study retrospectivally compared the two methods in 112 patients and LHM was found to be superior regarding efficacy compared to PD both in the short-(1 year) (92% vs 80%) and long-term (5 years) (80% vs 64%).…”

Section: Heller Myotomymentioning

confidence: 72%

“…In addition, several authors have also reported similar patient outcomes after myotomy even after prior failed pneumatic dilation or Botulinum toxin injections Surgery after botulinum toxin injections has been suggested to be more difficult because of a marked fibrotic reaction that can develop at the gastroesophageal junction that obliterates surgical planes (62)(63)(64)(65). Nevertheless, some authors have reported similar outcomes in this situation to those of a primary procedure (66)(67)(68).…”

Section: Heller Myotomymentioning

confidence: 82%

“…In fact, surgical complication rates are thought to be more dependent on surgeon experience and the incidence of previous esophageal surgery than on prior botulinum toxin injection or prior pneumatic dilatation (68). In conclusion, LHM can be safley and efficiently performed after PD or Botox injections, but a careful approach by an experienced team is advisable.…”

Section: Heller Myotomymentioning

confidence: 99%

“…In line with these data, a romanian study retrospectivally compared the two methods in 112 patients and LHM was found to be superior regarding efficacy compared to PD both in the short-(1 year) (92% vs 80%) and long-term (5 years) (80% vs 64%). However, the limitations of these studies are either a low number of patients included, a short follow up period, or only subjective clinical scoring systems in considering treatment efficacy (68,69).…”

Section: Heller Myotomymentioning

confidence: 99%

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High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

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RezumatManometria esofagiană cu rezoluţie înaltă este actual investigaţia gold-standard în diagnosticul acalaziei şi a bolilor esofagiene funcţionale. Această examinare este întotdeauna precedată de endoscopia digestivă superioară, care are scopul de a face diagnosticul diferenţial al acalaziei cu pseudoacalazia (formaţiuni tumorale de fornix gastric/esofag distal). La momentul actual, nu există tratament curativ pentru acalazie. Însă, cele 3 subtipuri de acalazie (conform clasificării Chicago) au răspuns diferit în ceea ce priveşte eficacitatea în tratamentului ales. Astfel, comparativ cu tipurile I şi III, tipul II de acalazie are cel mai bun răspuns la intervenţiile terapeutice invazive (dilatare pneumatică sau cardiomiotomie Heller). În schimb, în tipul III cardiomiotomia Heller este de ales ca prima abordare terapeutică. Miotomia endoscopică perorală (POEM) este o tehnică relativ recentă, care necesită însă studii pe termen lung în ceea ce priveşte siguranţa şi eficacitatea. Articolul prezent îşi propune să prezinte variantele actuale de tratament ale acalaziei, comparându-le pe baza eficacităţii şi siguranţei pe termen scurt şi lung, subliniind de asemenea rolul manometriei cu rezoluţie înaltă în diagnosticul, alegerea metodei terapeutice şi prognosticul acestor pacienţi. Review ArticleAbstract High resolution manometry (HRM) is currently the gold standard for the diagnosis of achalasia and other functional esophageal disorders. All patients accusing dysphagia should be endoscopically evaluated prior to manometric investigations in order to rule out pseudoachalasia. The Chicago HRM classification has led to a subclassification of three manometric types of achalasia that seem to have different results to treatment. None of the actual achalasia treatment options are curative. Type II achalasia patients respond best to all treatment options compared to those with types I and III. Pneumatic dilation (PD) or Heller miotomy (LHM) can be both chosen as initial therapy in type I and II as they have good outcome , while type III achalasia patients respond better to LHM as a first therapeutic option. Peroral endoscopic myotomy (POEM) is a promising new technique but long-term follow-up studies for its safety and efficacy must be performed. This article reviews the current therapeutic options in achalasia and other functional esophageal disorders, based on the differences in safety and efficacy between approaches, highlighting the impact of HRM to predict the outcome but also the role of the techinque in guiding antireflux surgery.

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Section: Heller Myotomymentioning

confidence: 72%

Section: Heller Myotomymentioning

confidence: 82%

Section: Heller Myotomymentioning

confidence: 99%

Section: Heller Myotomymentioning

confidence: 99%

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High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Dimitriu¹,

Gheorghe²

2018

chr

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“…2,28,33,52,53 These studies have shown that BTox and PD are equally effective in the short-term but long-term relief of symptoms requires repeated injection of BTox. 52,53 Comparison of surgical myotomy and BTox injection also revealed that the probability of being symptom-free at two years was 87.5% after surgery and 34% after BTox.33 Surgical myotomy has better long-term control of symptoms and fewer complications when compared to PD. A recent population based study reported that both Heller myotomy and PD provided good relief of symptom.…”

Section: Choice Of Treatmentmentioning

confidence: 99%

Achalasia: What is the best treatment?

Ahmed

2008

Ann Afr Med

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Background: Achalasia is an infrequent primary motility disorder of the esophagus. Because of uncertain etiology, treatment is only palliative and is directed at decreasing lower esophageal sphincter pressure, improving esophageal emptying and relieving the symptoms of achalasia. Current treatment options include pharmacological, endoscopic and surgical. We undertook a systematic literature review of the management strategies currently available for achalasia. Method: A Medline, PubMed and Cochrane database search was conducted using reference manager 11. Original articles and reviews published in the English literature on the management of achalasia were reviewed. Emphasis was placed on articles published in the last ten years on randomized controlled trials comparing the various forms of treatment. Results: Esophageal manometry is the standard diagnostic evaluation for achalasia. Accurate diagnosis can also be made based on clinical findings and barium esophagogram. Medical treatment with nitrates or calcium channel blockers has variable results in alleviating the symptoms of achalasia but long-term results are disappointing because of tolerance and side effects. Intrasphincteric injection of botulinum toxin, pneumatic dilatation and surgical myotomy are variably effective at controlling the symptoms of achalasia but each modality has specific strength and weaknesses which make their choice suitable in a particular group of patients. While pneumatic dilatation is superior to botulinum toxin injection surgical myotomy provides the best long-term control of symptoms in patients with achalasia. Conclusion: Laparoscopic myotomy should be the initial treatment for most patients with achalasia. Pneumatic dilatation is the most cost-effective alternative but its long-term efficacy is less than that of surgical myotomy. Endoscopic botulinum toxin injection can be considered when other forms of treatment are contraindicated. Key words: Achalasia, Heller's esophagomyotomy, pneumatic dilatationRésumé Contexte: L'achalasie est une rare anomalie motrice de l'oesophage. En raison de son étiologie incertaine, le traitement est seulement palliatif et vise la réduire la pression sphinctérienne du bas oesophage, l'amélioration de la vidange et le soulagement des symptômes de l'achalasie. Les options thérapeutiques courantes font appel aux moyens pharmacologiques, endoscopiques et chirurgicaux. Nous avons effectué une revue systématique de la littérature relative aux stratégies thérapeutiques actuellement disponibles pour l'achalasie. Méthode: Une recherche sur Medline, Pubmed et Cochrane a été faite a l'aide du logiciel Reference Manager 11. Les articles originaux et les rapports portant sur la prise en charge de l'achalasie et publiés en anglaise ont été passés en revue. L'accent a été mis sur les articles publiés au cours des dix dernières années et sur les essais contrôlés comparant les diverses formes de traitement. Résultats: La manométrie oesophagienne est la méthode de diagnostic standard pour l'achalasie. Le dia...

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Laparoscopic cardiomyotomy versus endoscopic pneumatic dilation for primary achalasia

Kennedy

Sharma

Ahmad

et al. 2011

Cochrane Database of Systematic Reviews

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Pneumatic Dilatation or Laparoscopic Cardiomyotomy in the Management of Newly Diagnosed Idiopathic Achalasia

Abstract: Laparoscopic myotomy was found to be superior to an endoscopic balloon dilatation strategy in the treatment of achalasia when studied during the first 12 months after treatment.

Cited by 137 publications

References 71 publications

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

High Resolution Manometry - A Mandatory Examination in the Pre and Postoperative Assessment of Patients with Achalasia

Achalasia: What is the best treatment?

Laparoscopic cardiomyotomy versus endoscopic pneumatic dilation for primary achalasia

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