Outcomes of Minimally Invasive Myotomy for the Treatment of Achalasia in the Elderly

Craft, Randall O.; Aguilar, B; Flahive, Colleen; Merritt, Marianne V.; Chapital, Alyssa B.; Schlinkert, Richard T.; Harold, Kristi L.

doi:10.4293/108680810x12924466007368

Cited by 18 publications

(9 citation statements)

References 27 publications

(65 reference statements)

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“…It is the most common primary motility disorder of the esophagus; however, it occurs rarely, with an annual incidence of approximately 0.03–1/100,000 per year 1,4. Achalasia affects men and women equally and may occur at any age, from children to octogenarians 2,3,5…”

Section: Introductionmentioning

confidence: 99%

“…Achalasia (the word itself a Greek term that means “does not relax” 1 ) is a chronic benign disease with a subtle onset and symptoms that may progress gradually for years before exact diagnosis can be made. 2 , 3 It is the most common primary motility disorder of the esophagus; however, it occurs rarely, with an annual incidence of approximately 0.03–1/100,000 per year. 1 , 4 Achalasia affects men and women equally and may occur at any age, from children to octogenarians.…”

Section: Introductionmentioning

confidence: 99%

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Training in peroral endoscopic myotomy (POEM) for esophageal achalasia

Eleftheriadis¹,

Inoue²,

Ikeda³

et al. 2012

TCRM

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Training in peroral endoscopic myotomy (POEM) for esophageal achalasia

Eleftheriadis¹,

Inoue²,

Ikeda³

et al. 2012

TCRM

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“…The optimal treatment in older patients is a matter of controversy. Although a number of scholars have proved that laparoscopic Heller myotomy (LHM) is just as safe and effective in elderly patients as it is in young or middle‐aged patients, even with a more excellent long‐term efficacy, the overwhelming majority of elderly achalasia patients have pneumatic dilations, and only a minority undergo surgery myotomy or LHM . The reason for that might be due to a higher surgical risk associated with open myotomy or LHM in older patients.…”

Section: Discussionmentioning

confidence: 99%

Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients

Tang

Ren

Gao

et al. 2017

Geriatrics Gerontology Int

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“…The incomplete division of muscle fi bers is another reason for recurrence (28). Craft recommended the length of myotomy approximately 10 cm up the esophagus and 4cm down in the anterior gastric wall (29). Wright confi rmed the effi cacy of myotomy above 3 cm on to the stomach in terms of reducing persistent dysphagia (30).…”

Section: Discussionmentioning

confidence: 99%

The role of laparoscopic Heller myotomy in the treatment of achalasia

Zonča¹,

Cambal²,

Labas³

et al. 2014

BLL

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Aim: To evaluate the results of laparoscopic Heller myotomy in our group of patients. Method: A retrospective clinical trial was carried out to evaluate the indication, technique and controversies of laparoscopic Heller myotomy in the achalasia treatment. The following symptoms were evaluated prior and after Heller myotomy: dysphagia, heartburn, nausea/vomiting after meal and asthma/coughing. The patients were evaluated by the use of Likert score. Statistical analysis was performed by using Student t test. The intra-operative (operation time, intraoperative complications, blood loss, conversion rate), and peri-operative parameters (morbidity, mortality, hospital stay) were evaluated as well. The patients who underwent laparoscopic Heller myotomy were included in the trial. All patients were perioperatively managed by a multidisciplinary team. Results: The evaluation of fourteen patients was performed (average age: 53.2 yrs., eleven men, two women, BMI 23.6 kg/m 2). The patients were indicated for surgery in all of the stages (I-III). Previous semiconservative therapeutic modalities were performed in thirteen patients. The standard laparoscopic technique for Heller myotomy with semifundoplication was applied. All the observed symptoms were statistically improved after the surgery (p=0.05). The average operating time was 89 minutes. Intraoperative blood loss was below 20 ml. There was no conversion to open surgery. An average hospital stay was 4.3 days. Morbidity was 14.3 % and mortality 0 %. In one patient esophageal mucosa perforation was intra-operatively identifi ed and sutured. Post-operative course in this patient was without any complications. Conclusion: The laparoscopic Heller myotomy has become the "gold standard" procedure for achalasia. It is an excellent method allowing precise operation technique with good visualization of the esophagogastric junction. The operation with this approach is safe, effi cient, and with excellent reproducible operative results. The correct and early indication for surgery is crucial. The delayed diagnosis with a late indication for surgery is not an exemption (Tab. 2, Fig. 2, Ref. 36). Text in PDF www.elis.sk.

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Outcomes of Minimally Invasive Myotomy for the Treatment of Achalasia in the Elderly

Abstract: Laparoscopic Heller myotomy can safely be performed in elderly patients and can provide significant symptom relief.

Cited by 18 publications

References 27 publications

Training in peroral endoscopic myotomy (POEM) for esophageal achalasia

Training in peroral endoscopic myotomy (POEM) for esophageal achalasia

Peroral endoscopic myotomy is safe and effective in achalasia patients aged older than 60 years compared with younger patients

The role of laparoscopic Heller myotomy in the treatment of achalasia

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