Reintervention After Heller Myotomy for Achalasia: Is It Inevitable?

Raja, Siva; Schraufnagel, Dean P.; Blackstone, Eugene H.; Murthy, Sudish C.; Thota, Prashanthi N.; Thuita, Lucy; López, Rocío; Gabbard, Scott; Ray, Monica; Wadhwa, Neha; Sanaka, Madhu R.; Zanoni, Andrea; Rice, Thomas W.

doi:10.1016/j.athoracsur.2018.09.059

Cited by 15 publications

(15 citation statements)

References 34 publications

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“…A recent retrospective study of 218 patients after LHM also reported a much higher rate of reintervention of 23% (41 endoscopic, 4 surgical, and 5 both; after reintervention, the risk of another intervention within 2 years was 50%. 26 This higher rate of reintervention may be attributable to differences in the indications for intervention, which was based on annual timed barium esophogram as well as symptoms.…”

Section: Commentmentioning

confidence: 99%

Long-term Symptom Control After Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia

Doubova

Gowing

Robaidi

et al. 2021

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

Long-term Symptom Control After Laparoscopic Heller Myotomy and Dor Fundoplication for Achalasia

Doubova

Gowing

Robaidi

et al. 2021

The Annals of Thoracic Surgery

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“…It was recommended that lifelong surveillance together with regular TBS should be mandatory. 72 Overall, TBS should be in the diagnostic armamentarium of everyone treating achalasia, as it has a diagnostic as well as a predictive value. 73 Although TBS certainly represents an important adjunct for the diagnosis of achalasia, HRM remains the gold standard to assess any esophageal motility disorders.…”

Section: Is There a Diagnostic Or Predictive Value Of Tbs?mentioning

confidence: 99%

“…The authors demonstrated that most patients reexperienced at least one symptom after myotomy and about 20% of patients needed reinterventions. It was recommended that lifelong surveillance together with regular TBS should be mandatory 72 . Overall, TBS should be in the diagnostic armamentarium of everyone treating achalasia, as it has a diagnostic as well as a predictive value 73 …”

Section: Is There a Diagnostic Or Predictive Value Of Tbs?mentioning

confidence: 99%

Achalasia: physiology and diagnosis

Rieder

Fernandez‐Becker

Sarosiek

et al. 2020

Annals of the New York Academy of Sciences

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Achalasia is a rare motility disorder with incomplete relaxation of the lower esophageal sphincter and ineffective contractions of the esophageal body. It has been hypothesized that achalasia does not result from only one pathway but rather involves a combination of infectious, autoimmune, and familial etiological components. On the basis of other observations, a novel hypothesis suggests that a muscular form of eosinophilic esophagitis is involved in the pathophysiology of achalasia in some patients. This appears to progressively diminish the myenteric plexus at stage III, gradually destroy it at stage II, and finally eliminate it at stage I, the most advanced and final stage of achalasia. Although high-resolution manometry has identified these three different types of achalasia, another subset of patients with a normal-appearing sphincter relaxation has been proposed. Provocative maneuvers, such as the rapid drinking challenge, have recently been demonstrated to improve diagnosis in certain borderline patients, but have to be studied in more detail. However, whether the different types of achalasia will have a long-term impact on tailored therapies is still a matter of debate. Additionally, novel aspects of the standard timed barium swallow appear to be an important adjunct of diagnosis, as it has been shown to have a diagnostic as well as a predictive value.

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“…It would also demonstrate, as we have shown, that there is a low but finite time-dependent failure rate that may require patients to undergo reintervention to assist symptom palliation. 14 The idea of any intervention for patients with achalasia as a "one-and-done" event needs to be challenged.…”

Section: What Should Be the Real Study?mentioning

confidence: 99%