Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score

Shemmeri, Ealaf; Aye, Ralph W.; Farivar, Alexander S.; Bograd, Adam J.; Louie, Brian E.

doi:10.1007/s00464-019-06952-2

Cited by 22 publications

(22 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This difference did not reach statistical significance in our study and corroborated with the published literature [15]. Studies have shown that using the Eckardt score as the sole predictor of the surgical outcome can overestimate success rates [16].…”

Section: Discussionsupporting

confidence: 84%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

View full text Add to dashboard Cite

BackgroundHeller myotomy (HM) with partial fundoplication is the standard of care for achalasia cardia. However, the choice of partial fundoplication is controversial. In this study, we compared both types of fundoplication concerning subjective and objective parameters. MethodologyThis prospective comparative study comprised a total of 30 consecutive patients who underwent laparoscopic/robotic HM with either Dor fundoplication (DF) (n = 15) or Toupet fundoplication (TF) (n = 15). Preoperative baseline characteristics, intraoperative details, and postoperative complications were recorded. Patients were followed with Eckardt score, quality of life-related scores, 24-hour pH study, and highresolution manometry (HRM) at the one-year follow-up. ResultsThere was no significant difference between the two groups regarding preoperative baseline parameters, length of hospital stay, and postoperative complications. The HM+DF group had four (27%) patients with recurrence/failure with none in the HM+TF, but it was not significant (p = 0.79). Symptom scores were similar between the groups at six and 12 months of follow-up. One patient in the HM+DF group and two in the HM+TF group had significant pathological acid reflux (p = 0.483). On HRM, HM+TF showed a trend toward significance in terms of esophagogastric junction (EGJ) relaxation (p = 0.058) with a non-significant difference in median integrated relaxation pressure (p = 0.081). ConclusionsThe study showed a trend toward lower failure rates and improved EGJ relaxation with similar reflux rates in patients who underwent HM+TF compared to HM+DF. However, long-term follow-up is required to validate our findings with well-defined subjective and objective criteria.

show abstract

Section: Discussionsupporting

confidence: 84%

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Suman¹,

Varshney²,

Soni³

et al. 2022

Cureus

View full text Add to dashboard Cite

show abstract

“…High-resolution manometry (HRM) and timed barium esophagogram (TBE) provide objective evaluation and are supplements to the ES [ 12 ]. There is limited correlation between post-treatment symptoms and TBE, but TBE still predicts the need for re-intervention better than symptoms and HRM [ 13–15 ].…”

Section: Introductionmentioning

confidence: 99%

“…There is limited correlation between post-treatment symptoms and TBE, but TBE still predicts the need for re-intervention better than symptoms and HRM [ 13–15 ]. Nevertheless, the evaluation of treatment effect after achalasia therapy is, according to clinical experience, difficult and there is a call for an evaluation beyond the mainly symptom-based ES [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy

et al. 2021

View full text Add to dashboard Cite

Background and aims Peroral endoscopic myotomy (POEM) is an established therapy for achalasia, but outcome evaluation has often been limited to Eckardt score (ES). The present study was aimed to improve knowledge about outcome evaluation and predictive outcome factors by performing a comprehensive objective evaluation of achalasia patients treated by POEM. Methods This single centre prospective study reports outcome data 12 months after POEM in treatment-naive achalasia patients. A predefined follow-up protocol included ES, high resolution manometry, 24-h pH measurement, upper endoscopy and timed barium esophagogram (TBE). Univariate and multivariate regression analyses were performed to analyze association between post-POEM variables and identify predictive factors for objective outcome. Results Fifty patients were included with a drop-out rate of <5%. ES, lower oesophageal sphincter pressures, TBE heights and maximal oesophageal diameter were all reduced after POEM ( p < .001), and 28% (13/47) of the patients had a positive 24-h pH registration. An oesophageal diameter >3 cm after POEM was associated with treatment failure assessed by ES ( p = .04) and TBE ( p = .03). Advanced achalasia stage ( p = .02) and long symptom duration ( p = .04) were identified as independent predictive factors for poor outcome assessed by TBE. Conclusions The present study confirms that POEM is an efficient therapy for achalasia. The comprehensive objective evaluation after POEM demonstrates that long symptom duration and major changes in oesophageal anatomy at diagnosis imply poor treatment outcome, and a post-POEM dilated oesophagus is associated with treatment failure. Key messages Peroral endoscopic myotomy (POEM) is established as a safe and effective therapy for achalasia. Timed barium esophagogram offers objective variables that are valuable in treatment response evaluation. Advanced achalasia stage and long symptom duration are predictive factors for poor objective treatment response after POEM.

show abstract

“…The report card ranged between 45% to 80% success in treating this esophageal motor disorder. 36 As esophageal health care providers, this type of clinical patient report card should be standardized and used consistently to obtain uniform clinical outcomes. Achieving a medical assessment of this report card will help us to review our clinical outcomes and provide realistic expectations for patients after treating this rare esophageal motor disorder.…”

Section: Discussionmentioning

confidence: 99%

Esophageal Achalasia: From Laparoscopic to Robotic Heller Myotomy and Dor Fundoplication

Arcerito

Jamal²,

Perez

et al. 2022

JSLS

View full text Add to dashboard Cite

Objective: Laparoscopic Heller myotomy and Dor fundoplication has become the gold standard in treating esophageal achalasia and robotic surgical platform represents its natural evolution. The objective of our study was to assess durable long-term clinical outcomes in our cohort.Methods and Procedures: Between June 1, 1999 and June 30, 2019, 111 patients underwent minimally invasive treatment for achalasia (96 laparoscopically and 15 robotically). Fifty-two were males. Mean age was 49 years (20 -96). Esophageal manometry confirmed the diagnosis. Fifty patients underwent pH monitoring study, with pathologic reflux in 18. Preoperative esophageal dilation was performed in 76 patients and 21 patients received botulin injection. Dysphagia was universally present, and mean duration was 96 months (5 -480).Results: Median operative time was 144 minutes (90 -200). One patient required conversion to open approach. Four mucosal perforations occurred in the laparoscopic group and were repaired intraoperatively. Seven patients underwent completion esophageal myotomy and added Dor fundoplication. Upper gastrointestinal series was performed before discharge. Median hospital stay was 39 hours (24 -312). Median follow up was 157 months (6 -240), and dysphagia was resolved in 94% of patients. Seven patients required postoperative esophageal dilation.Conclusions: Minimally invasive Heller myotomy and Dor fundoplication are feasible. The operation is challenging, but excellent results hinge on the operative techniques and experience. The high dexterity, three-dimensional view, and the ergonomic movements of robotic surgery allow application of all the technical elements, achieving the best durable outcome for the patient. Robotic surgery is the natural evolution of minimally invasive treatment of esophageal achalasia.

show abstract

Use of a report card to evaluate outcomes of achalasia surgery: beyond the Eckardt score

Cited by 22 publications

References 18 publications

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

Comparative Analysis of Heller Myotomy With Dor Versus Toupet Fundoplication for Achalasia Cardia

One year comprehensive prospective follow-up of achalasia patients after peroral endoscopic myotomy

Esophageal Achalasia: From Laparoscopic to Robotic Heller Myotomy and Dor Fundoplication

Contact Info

Product

Resources

About