The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation

Sweet, Matthew P.; Nipomnick, Ian; Gasper, Warren J.; Bagatelos, Karen C.; Ostroff, James W.; Fisichella, P. Marco; Way, Lawrence W.; Patti, Marco G.

doi:10.1007/s11605-007-0275-z

Cited by 110 publications

(68 citation statements)

References 19 publications

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“…There is a strong association between age at which diagnosis of achalasia is first established and the requirement for HM [50] . For each year of increasing age, the odds ratio for the eventual requirement for myotomy decreases by 0.943 (95% CI: 0.90-0.98).…”

Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Li²

2008

WJG

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AIM:To evaluate the efficacy and safety of Heller myotomy (HM) for recurrent achalasia, performed after different methods of first-line treatment. METHODS:We searched for studies published in PubMed from 1966 to March 2008 on treatment of recurrent achalasia with HM after failure with different methods of first-line treatment. The efficacy of HM was assessed by a pooled estimate of response rate with individual studies weighted proportionally to sample size. RESULTS: Sixteen studies were eligible and included in the review. The results showed that HM has a better remission rate for recurrent achalasia after failure of HM [weighted mean (SD)] of 86.9% (21.8%) compared with 81.6% (23.8%) for pneumatic dilatation (PD). One study evaluated the efficacy of HM after failure of PD combined with botulinum toxin injection (83%). The most common complications were perforation and gastroesophageal reflux. CONCLUSION: HM has the best efficacy in patients with recurrent achalasia who were treated with HM as first-line treatment. Future studies should focus on how to increase the success rate and decrease the complications of HM.

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Section: Discussionmentioning

confidence: 99%

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

Wang¹,

Li²

2008

WJG

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“…Despite this, surgical myotomy remains the preferred modality for achalasia in the United States; perhaps because of medical-legal concerns related to PD perforation and the usual more durable response with myotomy [13] . The degree of esophageal dilation of the achalasia esophagus is less of a concern to the surgeon then previously, but the operator must ensure an adequate myotomy and distal esophagectomy (6+ cm), and up to 20% of patients may require repeat intervention [14] .…”

Section: Prior Conventional Treatments For Achalasiamentioning

confidence: 99%

Per-oral endoscopic myotomy for achalasia: An American perspective

Friedel

Modayil²,

Iqbal³

et al. 2013

WJGE

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Achalasia is an uncommon esophageal motility disorder characterized by the selective loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower esophageal sphincter. Per-oral endoscopic myotomy (POEM) is a novel modality for the treatment of achalasia performed by gastroenterologists and surgeons. It represents a natural orifice transluminal endoscopic surgery (NOTES) approach to Heller myotomy. POEM has the minimal invasiveness of an endoscopic procedure that can duplicate results of the surgical Heller myotomy. POEM is conceptually similar to a surgical myotomy without the inherent external incisions and post-operative care associated with surgery. Initial high success and low complications rates promise a great future for this technique. In fact, POEM has been successfully performed on patients with end-stage achalasia as an initial treatment reserving esophagectomy for those without good response. The volume of POEMs performed worldwide has grown exponentially. In fact, surgeons who have performed Heller myotomy have embraced POEM as the preferred intervention for achalasia. However, the niche of POEM remains to be defined and long term results are awaited. We describe our experience with POEM having performed the first POEM outside of Japan in 2009, the evolution of our technique, and give our perspective on its future. Key words: Per-oral endoscopic myotomy; Achalasia; Heller myotomy; Natural orifice transluminal endoscopic surgery; Per-oral endoscopic myotomy; Minimally invasive surgery Core tip: Per-oral endoscopic myotomy (POEM) is a minimally invasive endoscopic procedure that duplicates results of the surgical Heller myotomy. This innovative technique has been performed by both gastroenterologists and surgeons. POEM has been shown to be safe and effective in patients with classic achalasia and modest follow-up data. POEM has also been successfully applied in patients with hypertensive esophageal motor disorders as well as end-stage achalasia. It is recommended that prior to performing POEM, operators should have experience in endoscopic submucosal dissection or substantial training in animal models.

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“…Another study showed that patients with stage I-III disease on preoperative evaluation had 90% satisfactory clinical outcome that was maintained during long-term follow-up, whereas patients with stage IV disease responded only 50% of the time and even the responders demonstrated symptom deterioration over time [47]. On the other hand, other studies have shown treatment responses even in (selected) patients with dilated esophageal bodies or sigmoid esophagus [33,104,105]. In addition, the rate of improvement after myotomy even in patients with a normotensive or hypotensive LES has been reported to be similar to those with a hypertensive LES in some other studies [106].…”

Section: Predictors Of Successful Outcomes After Myotomymentioning

confidence: 99%

SAGES guidelines for the surgical treatment of esophageal achalasia

et al. 2011

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PreambleThe guidelines for the surgical treatment of esophageal achalasia are a series of systematically developed statements to assist surgeon (and patient) decisions about the appropriate use of minimally invasive techniques for the treatment of achalasia in specific clinical circumstances. It addresses the indications, risks, benefits, outcomes, alternatives, and controversies of the procedures used to treat this condition. The statements included in this guideline are the product of a systematic review of published work on the topic, and the recommendations are explicitly linked to the supporting evidence. The strengths and weaknesses of the available evidence are highlighted, and expert opinion is sought where published evidence lacks depth. DisclaimerClinical practice guidelines are intended to indicate the best available approach to medical conditions as established by a systematic review of available data and expert opinion. The approach suggested may not necessarily be the only acceptable approach given the complexity of the healthcare environment. These guidelines are intended to be flexible, because the surgeon must always choose the approach best suited to the individual patient and variables in existence at the moment of decision. These guidelines are applicable to all physicians who are appropriately credentialed and address the clinical situation in question, regardless of specialty.Guidelines are developed under the auspices of SAGES-the guidelines committee-and are approved by the Board of Governors. The recommendations of each guideline undergo multidisciplinary review and are considered valid at the time of production based on the data available. New developments in medical research and practice pertinent to each guideline are reviewed, and guidelines will be periodically updated. Literature review methodA systematic literature search was performed on MED-LINE in October 2010. The search strategy was limited to adult English language articles and is shown in Fig. 1.We identified 214 relevant articles. The abstracts were reviewed by four committee members (DS, WR, TMF, and GPK) and divided into the following categories:(a) Randomized studies, meta-analyses, and systematic reviews and Other Interventional Techniques (b) Prospective studies (c) Retrospective studies (d) Case reports (e) Review articlesRandomized controlled trials, meta-analyses, and systematic reviews were selected for further review along with prospective and retrospective studies that included at least 50 patients. Studies with smaller samples were considered when additional evidence was lacking. The most recent reviews also were included. All case reports, old reviews, and smaller studies were excluded. According to these exclusion criteria, 102 articles were selected for review. Whenever the available evidence from Level I studies was considered to be adequate, lower evidence level studies were not considered.The reviewers graded the level of evidence and manually searched the bibliography of each article for additional articl...

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The Outcome of Laparoscopic Heller Myotomy for Achalasia is Not Influenced by the Degree of Esophageal Dilatation

Cited by 110 publications

References 19 publications

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

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

Per-oral endoscopic myotomy for achalasia: An American perspective

SAGES guidelines for the surgical treatment of esophageal achalasia

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