Laparoscopic Heller-Dor Is an Effective Treatment for Esophageal-Gastric Junction Outflow Obstruction

Salvador, Renato; Provenzano, Luca; Nezi, Giulia; Capovilla, Giovanni; Nicoletti, Loredana; Pierobon, Elisa Sefora; Moletta, Lucia; Valmasoni, Michele; Merigliano, Stefano; Costantini, Mario

doi:10.1007/s11605-021-05021-1

Cited by 13 publications

(4 citation statements)

References 24 publications

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“…Patients with a hypertensive LES or true gastroesophageal junction outflow obstruction (GEJOO) have a high intrabolus pressure and require a myotomy of the sphincter to relieve dysphagia. 25,26 The other observation is that even surgeons, who do not tailor fundoplication, obtain HRM prior to MSA. This suggests that even this group of surgeons believe that there is a level of outflow resistance at the GEJ that induces dysphagia in patients with inadequate peristaltic contraction.…”

Section: The Inconsistency In Literature Regarding Tailoring Approachmentioning

confidence: 99%

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

Ayazi

2021

Foregut

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Manometric assessment of the gastroesophageal junction (GEJ) and esophageal body is the key to a better understanding of the mechanics of antireflux surgery (ARS) and maximizing its benefits while minimizing adverse outcomes. However, there is an attitude of uncertainty regarding the necessity of esophageal motility prior to ARS among some surgeons. This evidence-based review highlights the critical role of manometry in the preoperative workup for patients undergoing ARS. It also discusses how manometry can detect findings associated with favorable outcomes or the risk of postoperative dysphagia. Manometric data can be used for risk stratification and the prediction of outcomes, aiding the surgeon in matching an operation to the specific physiology of each individual patient.

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Section: The Inconsistency In Literature Regarding Tailoring Approachmentioning

confidence: 99%

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

Ayazi

2021

Foregut

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“…During the drafting of the present study, patients were also contacted telephonically to obtain an update on their clinical conditions. Treatment failure was defined as the persistence or recurrence of an Eckardt score > 3, or the need for further treatment (pneumatic dilation, POEM, redo-myotomy or esophagectomy) [13]. Fig.…”

Section: Postoperative Assessmentmentioning

confidence: 99%

Laparoscopic Heller-Dor is an effective long-term treatment for end-stage achalasia

et al. 2022

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Background The end-stage achalasia is a difficult condition to treat, for the esophageal diameter and conformation of the gullet, that may progress to a sigmoid shape. The aim of this study was to examine the outcome of Laparoscopic Heller-Dor in patients with end-stage achalasia, comparing them with patients who had mega-esophagus without a sigmoid shape. Methods From 1992 to 2020, patients with a diagnosis of sigmoid esophagus, or radiological stage IV achalasia (the SE group), and patients with a straight esophagus larger than 6 cm in diameter, or radiological stage III achalasia (the NSE group), were all treated with LHD. The two groups were compared in terms of patients’ symptoms, based on the Eckardt score, and on barium swallow, endoscopy and manometry performed before and after the treatment. The failure of the treatment was defined as an Eckardt score > 3, or the need for further treatment. Results The study involved 164 patients: 73 in the SE group and 91 in the NSE group. No intra- or postoperative mortality was recorded. The median follow-up was 51 months (IQR 25–107). The outcome was satisfactory in 71.2% of patients in the SE group, and in 89% of those in the NSE group (p = 0.005). Conclusions SE is certainly the worst condition of the disease and the final outcome of LHD, in term of symptom control, is inferior compared to NSE. Despite this, almost 3/4 of the SE patients experienced a significant relieve in symptoms after LHD, which may therefore still be the first surgical option to offer to these patients, before considering esophagectomy.

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“…One group of investigators found that 55% of their EGJOO patients had an achalasia-like disorder as determined by a substantial drop in IRP during HRM with the administration of the smooth muscle relaxant amyl nitrite [45], and patients with achalasia-like EGJOO can respond well to typical achalasia treatments [46]. A recent prospective study of 25 such EGJOO patients showed that Heller myotomy was safe and effective in reducing symptoms as determined by the Eckardt score [47]. Thus, FLIP panometry can help guide treatment – if FLIP provides support for primary LES dysfunction as the etiology for EGJOO, then invasive treatment aimed at the LES (botulinum toxin injection, pneumatic dilation, Heller myotomy, peroral endoscopic myotomy (POEM)) might be warranted.…”

Section: Functional Luminal Imaging Probe Panometry Guiding Esophagog...mentioning

confidence: 99%

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction

Ellison

Nguyen²

2022

Current Opinion in Gastroenterology

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Purpose of reviewEsophagogastric junction outflow obstruction (EGJOO) comprises a heterogeneous group of conditions that demonstrate impaired deglutitive relaxation of the esophagogastric junction (EGJ) with intact esophageal peristalsis on high-resolution manometry. Functional luminal imaging probe (FLIP) panometry is a powerful tool that can help to clarify the etiology of this manometric diagnosis. The aim of this review is to summarize the use of FLIP for the evaluation and management of EGJOO.Recent findingsFLIP panometry provides measures of esophageal compliance at the EGJ and information on esophageal body contractile responses to balloon distention that have important implications for the management of patients with EGJOO. After excluding anatomic causes of impaired EGJ distensibility, FLIP panometry is useful in differentiating true lower esophageal sphincter dysfunction from manometric artifact. FLIP panometry has been shown to be useful in determining the need for invasive treatment in patients with EGJOO, and in intraoperative tailoring of myotomy procedures.SummaryFLIP panometry is easy to perform during endoscopy and provides useful information for characterizing the EGJOO population. FLIP panometry can be used to guide treatment and improve outcomes in the management of patients with EGJOO.

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Laparoscopic Heller-Dor Is an Effective Treatment for Esophageal-Gastric Junction Outflow Obstruction

Cited by 13 publications

References 24 publications

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

Esophageal Manometry Testing and Anti-Reflux Surgery: The Preoperative Necessity and Prognostic Utility

Laparoscopic Heller-Dor is an effective long-term treatment for end-stage achalasia

Functional luminal imaging probe in the evaluation of esophago-gastric junction outflow obstruction

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