The effects of previous treatment on the results of myotomy for achalasia

Patti, Mg; Feo, Carlo V.; Arcerito, Massimo; Pinto, Mario De; Ahmadi, Mohammad Reza; Tong, Jenny; Gantert, Walter; Tyrrell, D; Way, Lww

doi:10.1016/s0016-5085(98)81036-6

Cited by 50 publications

(67 citation statements)

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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%

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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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Section: Heller Myotomymentioning

confidence: 82%

“…For example, Portale et al reported that patients who previously underwent Botox injection and PD had less successful outcome in LHM and increased risk of mucosal perforation, probably due to fibrosis at the GE junction (64,65).…”

Section: Heller Myotomymentioning

confidence: 99%

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

Dimitriu¹,

Gheorghe²

2018

chr

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“…previous pneumatic dilation is considered to increase the risk of perforation during myotomy due to a more difficult identification of the dissection planes (35). This has also been reported in patients with botulinum toxin injection prior to surgery and associated with inferior outcomes of the surgical results (36). According to Ellis, the possible causes of cardiomyotomy failure are as follows (in order of increased frequency): the late occurrence of carcinoma, the presence of a decompensated ''sigmoid-shaped'' megaesophagus preoperatively, gastroesophageal reflux, a tight fundoplication, and inadequate myotomy (caused either by incomplete section of the muscle fibres or by healing of the myotomy edges with fibrosis) (37).…”

Section: Complications and Failuresmentioning

confidence: 98%

Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options

Gockel¹,

Sgourakis²,

Drescher³

et al. 2011

Scand J Surg

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minimally invasive heller myotomy has evolved the "gold standard" procedure for achalasia in the spectrum of current treatment options. the laparoscopic technique has proved superior to the thoracoscopic approach due to improved visualization of the esophagogastric junction. operative controversies most recently include the length of the myotomy, especially of its fundic part, with respect to the balance between postoperative persistent dysphagia and development of gastroesophageal reflux, as well as the type of the added antireflux procedure. perioperative mortality should approach 0%, and favorable long-term results can be achieved in > 90%.

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“…It is thought that BTI at the gastroesophageal junction causes fibrosis which obliterates the surgical planes, thereby increasing the difficulty of the myotomy [Patti et al 1999;Horgan et al 1999]. However, there are other studies that show no difference in intraoperative complications, degree of surgical difficulty or symptom improvement with prior endoscopic treatment [Deb et al 2005;Patti et al 1999;Rosemurgy et al 2005].…”

Section: Endoscopic Therapy Prior To Heller Myotomymentioning

confidence: 99%

Endoscopic approaches to treatment of achalasia

Stavropoulos

Friedel

Modayil

et al. 2012

Therap Adv Gastroenterol

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Endoscopic therapy for achalasia is directed at disrupting or weakening the lower esophageal sphincter (LES). The two most commonly utilized endoscopic interventions are large balloon pneumatic dilation (PD) and botulinum toxin injection (BTI). These interventions have been extensively scrutinized and compared with each other as well as with surgical disruption (myotomy) of the LES. PD is generally more effective in improving dysphagia in achalasia than BTI, with the latter reserved for infirm older people, and PD may approach treatment results attained with myotomy. However, PD may need to be repeated. Small balloon dilation and endoscopic stent placement for achalasia have only been used in select centers. Per oral endoscopic myotomy is a newer endoscopic modality that will likely change the treatment paradigm for achalasia. It arose from the field of natural orifice transluminal endoscopic surgery and represents a scarless endoscopic approach to Heller myotomy. This is a technique that requires extensive training and preparation and thus there should be rigorous accreditation and monitoring of outcomes to ensure safety and efficacy.

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The effects of previous treatment on the results of myotomy for achalasia

Cited by 50 publications

References 0 publications

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

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

Impact of Minimally Invasive Surgery in the Spectrum of Current Achalasia Treatment Options

Endoscopic approaches to treatment of achalasia

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