Abstract
Background
The Heller-Dor associated with the verticalization of distal esophagus (pull-down technique PD-HD) or esophagectomy (E) may be indicated for therapy of dysphagia in end-stage achalasia the latter also prevents development of carcinoma. We compared results achieved after PD-HD and E.
Methods
Twenty-nine patients (median age 57 years IQR 49–69 years) were submitted to PD-HD and 20 patients (median age 64 years IQR 56–69 years) (P = 0.321) were submitted to E for end stage achalasia or for cancer (patients recurrence free). We adopted semi quantitative scales to investigate dysphagia, reflux symptoms and esophagitis. With SF-36 quality of life was assessed.
Results
Median follow-up was 134.13 months (IQR 92.36 - 167.03 months) for PD-HD and 42.77 months (IQR 23.57 - 65.17 months) for E (P = 0.001). No statistically significant differences were observed with regards to the objective evaluation of dysphagia, reflux symptoms and esophagitis (P = 0.515). No statistically significant differences were calculated between the two groups as it concerns the domains general health (P = 0.302), physical functioning (P = 0.275), role physical (P = 0.107) and bodily pain (P = 0.057). Significant differences with regards to the domains role emotional (PD-HD 100, E 75, P = 0.012), vitality (PD-HD 90, E 60, P < 0.001), mental health (PD-HD 92, E 69, P = 0.001) and social functioning (PD-HD 100, E 75, P = 0.014) were observed in favour of PD-HD (Figure).
Conclusion
With respect to E, PD-HD achieved similar dysphagia, GER control, better quality of life. PD-HD is the procedure of choice for patients with low or null risk for cancer.
Disclosure
All authors have declared no conflicts of interest.
Abnormal 24-hour pH-impedance Testing Does Not Predict Reduced Quality of Life in Children With Reflux Symptoms
