Partial Recovery of Peristalsis After Myotomy for Achalasia

Roman, Sabine; Kahrilas, Peter J.; Mion, François; Nealis, Thomas B.; Soper, Nathaniel J.; Poncet, Gilles; Nicodème, Frédéric; Hungness, Eric S.; Pandolfino, John E.

doi:10.1001/2013.jamasurg.38

Cited by 64 publications

(60 citation statements)

References 27 publications

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“…Within this concept, recovery of peristalsis after myotomy might indicate an inflamed, but surviving, distal oesophageal myenteric plexus, whereas lack of recovery might indicate progression to aganglionosis. In support of this hypothesis, post-myotomy peristalsis in the Roman et al study was usually characterized as weak with low DCI values 34 . Along the same lines, FLIP detected non-occluding or occluding contractions in 10 of 10 patients with type III achalasia, two-thirds of the 26 patients with type II achalasia tested and one-third of the 15 patients with type I achalasia 42 .…”

Section: Achalasia With Preserved Peristalsismentioning

confidence: 59%

“…Roman et al 34 demonstrated this effect in a series of patients with achalasia studied with HRM before and after undergoing Heller myotomy surgery. More than half of the 30 patients studied exhibited instances of either intact peristaltic contractions or remnants of distal peristalsis in their HRM study after treatment.…”

Section: Achalasia With Preserved Peristalsismentioning

confidence: 87%

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Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

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High-resolution manometry (HRM), along with the analysis algorithms characterized in the Chicago Classification (CC) first proposed in 2008, have led to a major restructuring of the classification of oesophageal motility disorders. The inherently quantitative output of HRM devices fuelled enthusiastic expectation among motility experts that these advances would add a level of precision to the diagnosis of oesophageal motility disorders that was not previously possible. Nowhere was this advance more evident than in our concept of achalasia, now differentiated into subtypes as a direct result of HRM. Coincident with the assimilation of HRM into clinical practice was the development of a major therapeutic intervention for the management of oesophageal motility disorders, per-oral endoscopic myotomy (POEM). Not only does the POEM procedure provide a therapeutic option for myotomy with reduced morbidity relative to laparoscopic or open myotomy, but it also enables a calibrated intervention that is customized to patient-specific physiology. Together, these develop ments fostered an increasing emphasis on targeting therapy to specific aspects of oesophageal dysfunction, as measured by physiological testing, rather than discrete diagnoses. Again, nowhere is this evolution more evident than in our strategies for managing achalasia. This Consensus Statement examines the effect of HRM on our current understanding of oesophageal motility disorders with a focus on how this technology has affected the diagnosis, epidemiology and management of achalasia and achalasia-like syndromes. on behalf of the International Working Group for Disorders of Gastrointestinal Motility and FunctionAbstract | High-resolution manometry (HRM) and new analysis algorithms, summarized in the Chicago Classification, have led to a restructured classification of oesophageal motility disorders. This advance has led to increased detection of clinically relevant disorders, in particular achalasia. It has become apparent that the cardinal feature of achalasia -impaired lower oesophageal sphincter (LES) relaxation -can occur in several disease phenotypes: without peristalsis (type I), with pan-oesophageal pressurization (type II), with premature (spastic) distal oesophageal contractions (type III), or with preserved peristalsis (outlet obstruction). Furthermore, no manometric pattern is perfectly sensitive or specific for achalasia caused by a myenteric plexopathy, and there is no biomarker for this pathology. Consequently, physiological testing reveals other syndromes not meeting achalasia criteria that also benefit from therapies formerly reserved for achalasia. These findings have become particularly relevant with the development of a minimally invasive technique for performing a long oesophageal myotomy, the per-oral endoscopic myotomy (POEM). Optimal management is to render treatment in a phenotype-specific manner; that is, POEM calibrated to patient-specific physiology for spastic achalasia and the spastic disorders, and more conservative strategies...

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Section: Achalasia With Preserved Peristalsismentioning

confidence: 59%

Section: Achalasia With Preserved Peristalsismentioning

confidence: 87%

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Kahrilas

Bredenoord

Fox

et al. 2017

Nat Rev Gastroenterol Hepatol

Self Cite

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“…It is thought that peristalsis may be preserved after treatment because esophageal inflammation is localized in the LES and dysfunction of the inhibitory ganglionic neuron is specific. This may be indicative of the unique pathogenic features of type III achalasia (19).…”

Section: Discussionmentioning

confidence: 97%

Changes in pressure waves after endoscopic intervention in patients with achalasia: A focus on peristaltic recovery of the esophageal body

Park

Hong

Han³

et al. 2016

Turk J Gastroenterol

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“…Although the exact cause of achalasia is unknown, most of the promising research focuses on viral and autoimmune etiologies. Currently treatment strategies offer symptomatic and functional relief through relaxation of LES barrier, there is also evidence of partial return of the peristaltic function of the esophagus after long term resolution of the outflow obstruction [3]. Endoscopic treatments like balloon dilatation and botulinum toxin injection can provide quick relief with low morbidity and mortality but repeated attempts may be needed to maintain quality of life [4].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic heller myotomy is equally efficient and safe in patients who had pre-myotomy endoscopic interventions when compared with those with no interventions

Bilgi¹,

Issaka²,

Batırel³

2017

Curr Thorac Surg

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Partial Recovery of Peristalsis After Myotomy for Achalasia

Cited by 64 publications

References 27 publications

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Advances in the management of oesophageal motility disorders in the era of high-resolution manometry: a focus on achalasia syndromes

Changes in pressure waves after endoscopic intervention in patients with achalasia: A focus on peristaltic recovery of the esophageal body

Laparoscopic heller myotomy is equally efficient and safe in patients who had pre-myotomy endoscopic interventions when compared with those with no interventions

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