scholarly journals Surgical Treatment for Achalasia of the Esophagus: Laparoscopic Heller Myotomy

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Gonzalo Torres-Villalobos ◽  
Luis Alfonso Martin-del-Campo
Keyword(s):  
Weight Loss ◽  
Surgical Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Newly Diagnosed ◽  
Robot Assisted ◽  
Esophageal Motility Disorder

Achalasia is an esophageal motility disorder that leads to dysphagia, chest pain, and weight loss. Its diagnosis is clinically suspected and is confirmed with esophageal manometry. Although pneumatic dilation has a role in the treatment of patients with achalasia, laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. This review will focus on the surgical treatment of achalasia, with special emphasis on laparoscopic Heller myotomy. We will also present a brief discussion of the evaluation of patients with persistent or recurrent symptoms after surgical treatment for achalasia and emerging technologies such as LESS, robot-assisted myotomy, and POEM.

scholarly journals Achalasia: current therapeutic options

2017 ◽  
Vol 8 (6-7) ◽  
pp. 101-108 ◽  
Author(s):  
Zubin Arora ◽  
Prashanthi N. Thota ◽  
Madhusudhan R. Sanaka
Keyword(s):  
Esophageal Motility ◽  
Heller Myotomy ◽  
Symptomatic Relief ◽  
Treatment Options ◽  
Motility Disorder ◽  
Pneumatic Dilation ◽  
Esophageal Peristalsis ◽  
Esophageal Motility Disorder ◽  
Endoscopic Myotomy ◽  
Esophageal Sphincter

Achalasia is a chronic incurable esophageal motility disorder characterized by impaired lower esophageal sphincter (LES) relaxation and loss of esophageal peristalsis. Although rare, it is currently the most common primary esophageal motility disorder, with an annual incidence of around 1.6 per 100,000 persons and prevalence of around 10.8/100,000 persons. Symptoms of achalasia include dysphagia to both solids and liquids, regurgitation, aspiration, chest pain and weight loss. As the underlying etiology of achalasia remains unclear, there is currently no curative treatment for achalasia. Management of achalasia mainly involves improving the esophageal outflow in order to provide symptomatic relief to patients. The most effective treatment options for achalasia include pneumatic dilation, Heller myotomy and peroral endoscopic myotomy (POEM), with the latter increasingly emerging as the treatment of choice for many patients. This review focusses on evidence for current and emerging treatment options for achalasia with a particular emphasis on POEM.

scholarly journals Esophageal Manometry with Provocative Testing in Patients with Noncardiac Angina-Like Chest Pain

1991 ◽  
Vol 5 (2) ◽  
pp. 51-57 ◽  
Author(s):  
William G Paterson ◽  
Delia A Marciano-D’Amore ◽  
Ivan T Beck ◽  
Laurington R Da Costa
Keyword(s):  
Chest Pain ◽  
Esophageal Motility ◽  
Esophageal Manometry ◽  
Motility Disorder ◽  
Diffuse Esophageal Spasm ◽  
Esophageal Motility Disorder ◽  
Nutcracker Esophagus ◽  
Hypertensive Lower Esophageal Sphincter ◽  
Acid Perfusion ◽  
Provocative Testing

In a five year period 238 of 594 esophageal manometric studies performed in the authors’ laboratory were done on patients whose major reason for referral was noncardiac angina-like chest pain. Standard eophageal manometry was performed followed by an acid-antacid perfusion period (Bernstein test) and then subcutaneous bethanechol (80 μg/kg to a maximum of 5 mg) was adminstered. Baseline manometry was normal in 38% of patients and was diagnostic of ‘nutcracker’ esophagus, nonspecific esophageal motility disorder, diffuse esophageal spasm and isolated hypertensive lower esophageal sphincter in 24%, 19%, 16% and 3% of patients, respectively. Ninety-six of 238 patients (40%) experienced reproduction of their presenting angina-like chest pain during acid perfusion. In 80% of these patients there were associated esophageal motor abnormal ilies induced by the acid perfusion. Thirty-six of 212 (17%) experienced pain reproduction following the injection of bethanechol; however, 16 of these had already had their presenting chest pain reproduced during the acid perfusion study. In two-thirds of the patients with pain reproduction following bechanechol there was an associated bethanechol-induced esophageal motility disorder. Overall 49% of patients had their pain reproduced during provocative testing. The acid perfusion test reproduced the pain much more frequently than bethanechol simulation. This study reaffirms the value of esophageal manometry and provocative testing in this group of patients.

scholarly journals Imaging in the Evaluation of Endoscopic or Surgical Treatment for Achalasia

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Diego Palladino ◽  
Andrea Mardighian ◽  
Marilina D’Amora ◽  
Luca Roberto ◽  
Francesco Lassandro ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Digestive Tract ◽  
Endoscopic Treatment ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Pneumatic Dilation ◽  
X Ray ◽  
Before And After ◽  
High Operative Risk ◽  
The Mean

Purpose.Aim of the study is to evaluate the efficacy of the endoscopic (pneumatic dilation) versus surgical (Heller myotomy) treatment in patients affected by esophageal achalasia using barium X-ray examination of the digestive tract performed before and after the treatment.Materials and Methods.19 patients (10 males and 9 females) were enrolled in this study; each patient underwent a barium X-ray examination to evaluate the esophageal diameter and the height of the barium column before and after endoscopic or surgical treatment.Results.The mean variation of oesophageal diameter before and after treatment is −2.1 mm for surgery and 1.74 mm for pneumatic dilation (OR 0.167, CI 95% 0.02–1.419, andP: 0.10). The variations of all variables, with the exception of the oesophageal diameter variation, are strongly related to the treatment performed.Conclusions.The barium X-ray study of the digestive tract, performed before and after different treatment approaches, demonstrates that the surgical treatment has to be considered as the treatment of choice of achalasia, reserving endoscopic treatment to patients with high operative risk and refusing surgery.

Pneumatic dilation versus laparoscopic Heller myotomy for the treatment of achalasia: variables related to a good response

2013 ◽  
Vol 27 (1) ◽  
pp. 18-23 ◽  
Author(s):  
A. A. Borges ◽  
E. M. de O. Lemme ◽  
L. J. Abrahao ◽  
D. Madureira ◽  
M. S. Andrade ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Pneumatic Dilation

Mo1874 Long-Term Results of the European Achalasia Trial: Pneumatic Dilation Versus Laparoscopic Heller Myotomy

2014 ◽  
Vol 146 (5) ◽  
pp. S-678 ◽  
Author(s):  
Moonen An ◽  
Vito Annese ◽  
Albert J. Bredenoord ◽  
Stanislas Bruley des Varannes ◽  
Olivier R. Busch ◽  
...  
Keyword(s):  
Heller Myotomy ◽  
Laparoscopic Heller Myotomy ◽  
Long Term Results ◽  
Pneumatic Dilation

Achalasia: Diagnosis, Management, and Clinical Course in 16 Children

PEDIATRICS ◽  
1983 ◽  
Vol 71 (5) ◽  
pp. 798-805
Author(s):  
William E. Berquist ◽  
William J. Byrne ◽  
Marvin E. Ament ◽  
Eric W. Fonkalsrud ◽  
Arthur R. Euler
Keyword(s):  
Lower Esophageal Sphincter ◽  
Initial Treatment ◽  
Esophageal Manometry ◽  
Heller Myotomy ◽  
Lower Esophageal Sphincter Pressure ◽  
Pneumatic Dilation ◽  
Sphincter Pressure ◽  
School Aged Children ◽  
Retrosternal Pain ◽  
Esophageal Sphincter

Clinical features, radiographic and esophageal manometry findings, and treatment results in 16 patients less than 15 years old with achalasia are described. Esophageal manometry performed in 15 patients showed results similar to those found in adults: (1) increased resting lower esophageal sphincter pressure, (2) incomplete or failure of relaxation of the lower esophageal sphincter on swallowing, and (3) ineffective or absence of peristalsis in all. The most common symptoms in the 16 patients were: dysphagia in 15, postprandial vomiting in 13, and retrosternal pain in five. The average duration from onset of symptoms to diagnosis was 28 months. The esophagram was diagnostic in all patients. Pneumatic dilation was the initial treatment in eight and was successful for more than 1 year in five. Two patients required two dilations and were then symptom-free for more than 1 year, but required a Heller myotomy. The remaining patients underwent Heller myotomy following failure of the second dilation. Three patients underwent myotomy and two patients had myotomy with fundoplication as initial treatment; only one remained symptomatic. Esophageal dilation using a pneumatic dilator should be the initial treatment of choice in school-aged children. However, if more than two dilations are required within 1 year, surgical management is recommended.

THE SURGICAL TREATMENT OF ACHALASIA ON LAPAROSCOPIC HELLER MYOTOMY WITH DOR ANTIREFLUX PROCEDURE AT HUE CENTRAL HOSPITAL

2020 ◽  
pp. 97-102
Author(s):  
Dung Phan Dinh Tuan ◽  
Hung Dang Ngoc ◽  
Loc Le
Keyword(s):  
Heller Myotomy ◽  
Clinical Symptoms ◽  
Laparoscopic Heller Myotomy ◽  
Antireflux Procedure ◽  
Pneumatic Dilation ◽  
Motor Disorder ◽  
Eckardt Score ◽  
Esophageal Sphincter ◽  
Prospective Analyses

Background: Achalasia is a primary motor disorder of the esophagus characterized by insufficient lower esophageal sphincter relaxation and loss of esophageal peristalsis. Diagnosis is confirmed by clinical symptoms, endoscopic, radiographic and manometric. Although pneumatic dilation has a role in the treatment of achalasia, laparoscopic Heller myotomy is considered by many experts as the best treatment modality for most patients with newly diagnosed achalasia. Objective: To evaluate the efficacy and safety of laparoscopic Heller myotomy with Dor antireflux procedure. Patients and Methods: Prospective analyses of the patients of achalasia undergoing laparoscopic Heller myotomy with Dor antireflux procedure from 01/2012 to 06/2020. We evaluated the data according to outcome measures, characteristics and treatment results of achalasia after laparoscopic Heller myotomy with Dor antireflux procedure. Results: We found 11 patients with achalasia were diagnosed and treated by laparoscopic. 100% of the patients have dysphagia, weight loss; 81.8% have chest pain and regurgitation. Mean operative duration was 148 ± 21 minutes. There was no complications had found in our patients. Follow-up after 3 - 6 months by Eckardt score show that 90.9% had a good result, 01 patient with persistent symtomps (Eckardt score > 3) had to undergo a pneumatic dilation. Conclusion: The results of the laparoscopic Heller myotomy with Dor antireflux procedure were safe and effective. Keywwords: Achalasia, laparoscopic Heller myotomy, Dor antireflux procedure

Sign in / Sign up

Export Citation Format

Share Document