Long-term Outcome of Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Possible Detrimental Role of Previous Endoscopic Treatment

Portale, Giuseppe; Costantini, Mario; Rizzetto, Christian; Guirroli, Emanuela; Ceolin, Martina; Salvador, Renato; Ancona, Ermanno; Zaninotto, Giovanni

doi:10.1016/j.gassur.2005.10.001

Cited by 100 publications

(70 citation statements)

References 26 publications

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“…Good clinical results with HM are associated with a reduction of LES pressure to < 10 mmHg. Whereas, some studies [41][42][43] have shown that the technical difficulties of performing HM increase in some patients with previous dilatation. Preoperative PD represents a risk factor for laparoscopic HM.…”

Section: Study Characteristicsmentioning

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: Study Characteristicsmentioning

confidence: 99%

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

Wang¹,

Li²

2008

WJG

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“…26 The consequence of prior injections of botulinum toxin in patients that subsequently require surgical therapy remains controversial. 27,28 Additionally, botulinum toxin has been used in patients in whom the surgical myotomy or pneumatic dilatation is unsuccessful. 22, 24 29-31 In addition to botulinum toxin injection, there is limited data on the use of polidocanol and ethanolamine injections into the LES.…”

Section: Endoscopic Therapymentioning

confidence: 99%

Review article: the management of achalasia – a comparison of different treatment modalities¹

Lake¹,

Wong²

2006

Aliment Pharmacol Ther

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SUMMARY BackgroundAchalasia is an uncommon primary oesophageal motor disorder with an unknown aetiology. Therapeutic options for achalasia are aimed at decreasing the lower oesophageal sphincter pressure, improving the oesophageal empting, and most importantly, relieving the symptoms of achalasia. Modalities for treatment include pharmacologic, endoscopic, pneumatic dilatation and surgical. The decision of which modality to use involves the consideration of multiple clinical and economic factors.

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“…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%

“…Several studies have reported higher intraoperative esophageal perforation rates during esophagomyotomy after prior endoscopic intervention (65)(66)(67).…”

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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Long-term Outcome of Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Possible Detrimental Role of Previous Endoscopic Treatment

Cited by 100 publications

References 26 publications

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

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

Review article: the management of achalasia – a comparison of different treatment modalities¹

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

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Long-term Outcome of Laparoscopic Heller-Dor Surgery for Esophageal Achalasia: Possible Detrimental Role of Previous Endoscopic Treatment

Cited by 100 publications

References 26 publications

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

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

Review article: the management of achalasia – a comparison of different treatment modalities1

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

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Review article: the management of achalasia – a comparison of different treatment modalities¹