Manometric and radiographic verification of esophageal body decompensation for patients with achalasia11No competing interests declared.

Shiino, Yutaka; Houghton, Scott G.; Filipi, Charles J.; Awad, Ziad T.; Tomonaga, Tetsuya; Marsh, Robert E.

doi:10.1016/s1072-7515(99)00091-5

Cited by 36 publications

(35 citation statements)

References 17 publications

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“…The morphological changes including dilation, swerve, and rotation make us call it sigmoid-type achalasia [2]. Although the diagnosis and treatment of achalasia are usually established early in the course of the disease, some patients still present later with a dilated and sigmoidshaped esophagus [3].…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, no therapy returns normal esophageal function. Treatment is therefore directed at lowering the LES pressure, with the aim of reducing the functional obstruction to bolus transit at this site.The sigmoid-shaped esophagus is considered to be the advanced stage of achalasia, in which the esophageal lumen is significantly dilated, swerved, and rotated [2]. Up to 10 % of all patients with long-standing achalasia (more than 10 years after first diagnosis) develop progressive…”

mentioning

confidence: 99%

“…The sigmoid-shaped esophagus is considered to be the advanced stage of achalasia, in which the esophageal lumen is significantly dilated, swerved, and rotated [2]. Up to 10 % of all patients with long-standing achalasia (more than 10 years after first diagnosis) develop progressive enlargement of the esophagus, which can lead to a sigmoid-shaped esophagus and/or megaesophagus [3].…”

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confidence: 99%

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Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Zhou

et al. 2014

Surg Endosc

107

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Section: Discussionmentioning

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Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Zhou

et al. 2014

Surg Endosc

107

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“…6,7 Although the diagnosis and treatment of achalasia are usually established early in the course of the disease, some patients still present later with a dilated and sigmoid-shaped esophagus. 8 The treatment of such end-stage achalasia is controversial, since some believe that an esophagectomy is indicated, 9,10 while others recommend a myotomy as the first step. 11,12 In this study, we (a) compared the results of a laparoscopic Heller myotomy and Dor fundoplication (LHMD) in patients with achalasia and various degrees of esophageal dilatation, and (b) assessed the role of endoscopic dilatation for patients with postoperative dysphagia.…”

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

Sweet

Nipomnick

Gasper

et al. 2008

Journal of Gastrointestinal Surgery

108

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In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in patients with achalasia and various degrees of esophageal dilatation; and (b) to assess the role of endoscopic dilatation in patients with postoperative dysphagia. One hundred and thirteen patients with esophageal achalasia were separated into four groups based on the maximal diameter of the esophageal lumen and the shape of the esophagus: group A, diameter<4.0 cm, 46 patients; group B, esophageal diameter 4.0-6.0 cm, 32 patients; group C, diameter>6.0 cm and straight axis, 23 patients; and group D, diameter>6.0 cm and sigmoid-shaped esophagus, 12 patients. All had a laparoscopic Heller myotomy and Dor fundoplication. The median length of follow-up was 45 months (range 7 months to 12.5 years). The postoperative recovery was similar among the four groups. Twenty-three patients (20%) had postoperative dilatations for dysphagia, and five patients (4%) required a second myotomy. Excellent or good results were obtained in 89% of group A and 91% of groups B, C, and D. None required an esophagectomy to maintain clinically adequate swallowing. These data show that (a) a laparoscopic Heller myotomy relieved dysphagia in most patients with achalasia, even when the esophagus was dilated; (b) about 20% of patients required additional treatment; (c) in the end, swallowing was good in 90%.

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“…We have found greater postoperative improvements in the domains such as role limitations due to physical problems and social function. Correlation with degree of dysphagia and pressure of lower oesophageal sphincter seems not surprising since the existence of symptoms and signs leading to modification of eating habits has also been shown to impair QOL in other benign oesophageal diseases [24].…”

Section: Discussionmentioning

confidence: 99%

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

Mineo

Ambrogi

2004

European Journal of Cardio-Thoracic Surgery

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Objective: To assess the long-term results and health-related quality of life in patients undergoing surgery for oesophageal achalasia. Methods: Thirty-nine patients with achalasia (25 males, mean age 42^13 years) underwent open-Heller myotomy and Dor fundoplication by the same surgeon. Long-term results were assessed by imaging, endoscopy, manometry, pH-metry, and Short Form 36 and Nottingham Health Profile questionnaires whenever applicable. Six patients were at radiological stage I, 20 were at stage II, 2 at stage III and 11 at stage IV. Dysphagia and regurgitation were scored according to the four-grade classification (1 ¼ no symptoms; 4 ¼ persistent symptoms). Pulmonary symptoms were present in six patients. Lower oesophageal pressure was 30^34 mmHg. Six patients had undergone previous pneumatodilation. Results: No procedure related mortality was recorded. Mean follow-up was 107^30 months (54 -177). Preoperative to 5-year postoperative mean decrement in lower oesophageal sphincter pressure was 12.3^8.3 mmHg ðP , 0:001Þ; in oesophageal width was 11.5^7.1 mm ðP , 0:001Þ; in dysphagia 1.8^0.8 ðP , 0:01Þ and regurgitation 1.4^0.7 ðP , 0:01Þ: Four patients presented relapse dysphagia and two of those were re-operated upon. Three patients developed acid reflux, which was satisfactorily treated with proton-pump inhibitors. Preoperative to 4-year postoperative quality of life scores were available for 20 patients. Questionnaires showed a significant improvement ðP , 0:001Þ especially in all psychosocial domains, which were correlated with postoperative dysphagia score and lower oesophageal sphincter pressure. Conclusion: Heller myotomy and Dor fundoplication is a safe and effective procedure that improves symptoms, functional status and especially psychosocial aspect of quality of life in the long term in oesophageal achalasia. q

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Manometric and radiographic verification of esophageal body decompensation for patients with achalasia11No competing interests declared.

Cited by 36 publications

References 17 publications

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

Peroral endoscopic myotomy for advanced achalasia with sigmoid-shaped esophagus: long-term outcomes from a prospective, single-center study

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

Long-term results and quality of life after surgery for oesophageal achalasia: one surgeon's experience1

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