The Risk of Esophageal Resection After Esophagomyotomy for Achalasia

Eldaif, Shady M.; Mutrie, Christopher J.; Rutledge, Caleb; Lee, Edward; Force, Seth D.; Miller, Joseph I.; Mansour, Kamal A.; Miller, Daniel

doi:10.1016/j.athoracsur.2009.02.078

Cited by 25 publications

(17 citation statements)

References 16 publications

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“…Therefore, we recommend initial treatment with a laparoscopic myotomy, reserving oesophagectomy for the failures. Nevertheless, 2–5% of patients with a mega-oesophagus will eventually require an oesophagectomy 8 37. Surgical expertise is key, with the most complications occurring in the first 50 operations 38.…”

Section: Laparoscopic Heller Myotomymentioning

confidence: 99%

Management of achalasia: surgery or pneumatic dilation

Richter

Boeckxstaens

2011

Gut

129

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Achalasia is an esophageal motility disorder of unknown cause, characterised by aperistalsis of the esophageal body and impaired lower esophageal sphincter relaxation. Patients present at all ages, primarily with dysphagia for solids/liquids and bland regurgitation. The diagnosis is suggested by barium esophagram or endoscopy and confirmed by esophageal manometry. Achalasia cannot be cured. Instead, our goal is to relieve symptoms, improve esophageal emptying and prevent the development of megaesophagus. The most successful therapies are pneumatic dilation and surgical myotomy. The advantages of pneumatic dilation include an outpatient procedure, minimal pain, return to work the next day, mild if any GERD, and can be performed in any age group and even during pregnancy. Pneumatic dilation does not hinder future myotomy, and all cost analyses find it less expensive than Heller myotomy. Laparoscopic myotomy with a partial fundoplication has the advantage of being a single procedure, dysphagia relief is longer at the cost of more troubling heartburn, and a myotomy may be more effective treatment in adolescents and younger adults, especially men. Over a two year horizon, the clinical success of pneumatic dilation and laparoscopic myotomy are comparable in a recent large European randomised trial. The prognosis for achalasia patients to return to near-normal swallowing and good quality of life are excellent, but few are "cured" with a single treatment and intermittent "touch up" procedures may be required.

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Section: Laparoscopic Heller Myotomymentioning

confidence: 99%

Management of achalasia: surgery or pneumatic dilation

Richter

Boeckxstaens

2011

Gut

129

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“…These first-line endoscopic treatments of achalasia are limited due to temporary relapse, and complications such as perforation and bleeding 3,4. In addition, surgical myotomy complications include gastroesophageal reflux (GER), stricture formation, and skin scarring 5,6. A potentially less invasive endoscopic method for division of the LES, using a needle-knife to cut the esophageal muscle from the luminal side, was described by Ortega et al7 in 1980.…”

Section: Introductionmentioning

confidence: 99%

Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study

et al. 2013

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Background/AimsAchalasia is a rare esophageal motility disorder. Recently, a novel endoscopic technique, peroral endoscopic myotomy (POEM), was introduced as an alternative treatment for achalasia. We report the results and short term outcomes of POEM for patients with achalasia.MethodsPOEM was performed in 13 patients with achalasia. The procedure consisted of creating a submucosal tunnel followed by endoscopic myotomy of circular muscle bundles. The mucosal entry was closed by conventional hemostatic clips. A validated clinical symptom score (Eckardt score) and high resolution manometry were used to evaluate the outcomes.ResultsBoth the clinical score of achalasia, as well as the resting lower esophageal sphincter (LES) pressure, were significantly reduced after POEM. Mean posttreatment Eckardt score was 0.4±0.7, compared to 6.4±1.9 prior to the treatment (p=0.001). The mean pretreatment and posttreatment LES pressure was 30.3 and 15.3 mm Hg, respectively (p=0.007). Following POEM, symptomatic relief from dysphagia without reflux symptoms was observed in all patients (13/13). No serious complications related to POEM were encountered.ConclusionsBased upon our initial experience, the authors believe that POEM is a feasible, safe, and effective treatment and may possibly substitute established treatments of refractory achalasia.

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“…69 Finally, it should be noted that subtotal esophagectomy remains an option for patients who do not respond to any of the above therapeutic measures. Although some authors have reported favorable results with surgical myotomy in patients with substantial esophageal enlargement, 70 positive outcomes are not generally achieved in such patients and esophagectomy may become necessary. Admittedly, esophagectomy is an extremely invasive therapy with high postoperative morbidity and mortality; however, favorable long-term results with significant symptomatic improvement can be achieved, even if multiple other therapeutic measures have failed.…”

Section: Surgical Treatmentmentioning

confidence: 92%

Treatment and surveillance strategies in achalasia: an update

Eckardt

2011

Nat Rev Gastroenterol Hepatol

148

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Controversy exists with regard to the optimal treatment for achalasia and whether surveillance for early recognition of late complications is indicated. Currently, surgical myotomy and pneumatic dilation are the most effective treatments for patients with idiopathic achalasia, and a multicenter, randomized, international trial has confirmed similar efficacy of these treatments, at least in the short term. Clinical predictors of outcome, patient preferences and local expertise should be considered when making a decision on the most appropriate treatment option. Owing to a lack of long-term benefit, endoscopic botulinum toxin injection and medical therapies are reserved for patients of advanced age and those with clinically significant comorbidites. The value of new endoscopic, radiologic or surgical treatments, such as peroral endoscopic myotomy, esophageal stenting and robotic-assisted myotomy has not been fully established. Finally, long-term follow-up data in patients with achalasia support the notion that surveillance strategies might be beneficial after a disease duration of more than 10-15 years.

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The Risk of Esophageal Resection After Esophagomyotomy for Achalasia

Cited by 25 publications

References 16 publications

Management of achalasia: surgery or pneumatic dilation

Management of achalasia: surgery or pneumatic dilation

Peroral Endoscopic Myotomy for Treatment of Achalasia: Initial Results of a Korean Study

Treatment and surveillance strategies in achalasia: an update

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