Endoscopic Treatment of Esophageal Achalasia: Experience of the Hepato-Gastroenterology Service of Fez (original) (raw)
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Endoscopic treatment of esophageal achalasia
World journal of gastrointestinal endoscopy, 2016
Achalasia is a motility disorder of the esophagus characterized by dysphagia, regurgitation of undigested food, chest pain, weight loss and respiratory symptoms. The most common form of achalasia is the idiopathic one. Diagnosis largely relies upon endoscopy, barium swallow study, and high resolution esophageal manometry (HRM). Barium swallow and manometry after treatment are also good predictors of success of treatment as it is the residue symptomatology. Short term improvement in the symptomatology of achalasia can be achieved with medical therapy with calcium channel blockers or endoscopic botulin toxin injection. Even though few patients can be cured with only one treatment and repeat procedure might be needed, long term relief from dysphagia can be obtained in about 90% of cases with either surgical interventions such as laparoscopic Heller myotomy or with endoscopic techniques such pneumatic dilatation or, more recently, with per-oral endoscopic myotomy. Age, sex, and manometr...
Vietnam Journal of Science, Technology and Engineering, 2021
Objective: to describe the clinical characteristics and lower esophageal sphincter (LES) pressures on highresolution manometry (HRM) in patients with achalasia pre-and post-treatment. Methods: a case series study was conducted in achalasia patients. Clinical symptoms, Eckardt score, upper gastrointestinal endoscopy, esophageal barium swallow, and HRM results were collected on baseline and Eckardt score and HRM results on follow-up were collected. Results: from June 2018 to December 2019, 14 patients were recruited including 6 males and 8 females with mean age of 34.6±10.5 y. The proportion of achalasia type I, II, and III were 28.6, 64.3, and 7.1%, respectively. The Eckardt score, LES resting pressure (for both baseline period and swallow phase) and 4-s integrated resting pressure (IRP4s) significantly decreased after treatment (p<0.05). There was a correlation between pre-treatment LES resting pressure (in swallow phase) and change in chest pain score (p=0.044, r=0.546) and a correlation between pre-treatment IRP4s and change in Eckardt score (p=0.041, r=0.549). IRP4s had no significant difference between treatment success and recurrence groups. After treatment, 11 patients had clinical success and 3 patients recurred/failed after a median of 4 mo. The diagnosis on HRM after treatment included 5 achalasia (4 type I and 1 type II), 1 esophagogastric junction outflow obstruction (EGJOO), 1 distal esophageal spasm (DES), 6 absent contractility, and 1 ineffective esophageal motility (IEM). Conclusion: Eckardt score, LES pressure, and IRP4s improved significantly after treatment. Besides the role of classification and treatment option, HRM could be used to predict the treatment outcome in achalasia.
Non-surgical treatment of esophageal achalasia
World Journal of Gastroenterology, 2006
Esophageal achalasia is an infrequent motility disorder characterized by a progressive stasis and dilation of the oesophagus; with subsequent risk of aspiration, weight loss, and malnutrition. Although the treatment of achalasia has been traditionally based on a surgical approach, especially with the introduction of laparoscopic techniques, there is still some space for a medical approach. The present article reviews the non-surgical therapeutic options for achalasia.
Achalasia of the Esophagus: Reflections Upon a Clinical Study of 33 Cases
Journal of the National Medical Association, 1987
Thirty-three patients who have suffered with dysphagia to solids and liquids for a varying number of years are reviewed. They all had a history and radiologic findings suggestive of achalasia of the esophagus. Thirty-one of the cases who had uncomplicated achalasia benefited from a transthoracic modified Heller's procedure. Lower esophageal diaphragm and carcinoma arising in the proximal half of the distal third of the esophagus occurred in association with achalasia in two patients. Over 90 percent had symptomatic relief of their symptoms. The only mortality was recorded in a patient who had palliative esophagogastrectomy for associated carcinoma. A properly performed anterior extramucosal esophagomyotomy is the safest and most effective procedure available, even in places with minimal facilities. The only important function of the esophagus is to transmit food from the mouth to the stomach, and any interference with this unique function of the esophagus leads to dysphagia. One of the frequent causes of dysphagia of the esophagus is achalasia, a disease of unknown etiology characterized primarily by failure of the esophagus to propel food normally through the body of the esophagus and the failure of the lower esophageal sphincter to relax enough to permit the entry of Requests for reprints should be addressed to Dr.
Therapeutics and Clinical Risk Management
Introduction: Peroral endoscopic myotomy (POEM) has been considered as a minimalinvasive, innovative technique for long-term treatment of all types of esophageal achalasia and other esophageal motility disorders. Patients and methods: We report on 20 consecutive Greek patients with manometrically proved esophageal achalasia (14 patients with type I, 4 with type II, 2 with type III, and 4 with sigmoid esophagus), with an age range of 32-92 years, mean age 59 years, 12 males, successfully treated by POEM from 2013 to 2015. The Eckardt score was 7-12 (type III). Seventeen (85%) POEM procedures were performed in the Endoscopy Department, according to a previous study. During POEM, CO 2 insufflation was mandatory, while the Triangle Tip knife was the only knife used in all procedures. Eckardt score, esophagogram and manometry before and after performing POEM were used for evaluation of our results. The follow-up period was 6 months to 3 years. Results: Selective circular myotomy, 10-13 cm in length, was successfully completed in all patients without severe acute or late complications. Three patients (15%) showed moderate pneumomediastinum and pneumoperitoneum, which was successfully managed by abdominal needle drainage during the procedure. One patient showed mild pleural collection, and in one patient the clip-endoloop technique was used to successfully close the mucosal entry after the completion of POEM. The outcome was uneventful without any further clinical consequences. No other short-or long-term serious complications were reported. Patients were discharged after 1-3 days of hospitalization. Six months to 3 years after the POEM procedure, all patients were alive; the majority (90%) had complete clinical improvement, while two patients with sigmoidtype achalasia showed moderate-to-significant clinical improvement. Erosive esophagitis was reported in 15%. Conclusion: Our results are in accordance with international data, and proved the safety and efficacy of the POEM technique for radical long-term treatment of all types of achalasia, including end-stage sigmoid-type achalasia, in the Endoscopy Department. However, long-term follow-up is necessary and awaited.
Recurrence of Esophageal Achalasia: Diagnosis and Treatment
Background: The aim of this study was to investigate the long-term clinical outcome of the laparoscopic Heller Dor procedure for esophageal achalasia. Methods: A total of 71 consecutive patients with a minimum 6 year follow-up were evaluated. These patients were seen at 1 and 6 months after the operation (at which time barium swallow, endoscopy, manometry, and pH monitoring were performed), and annually thereafter. A dedicated symptom score, that combined severity and frequency of symptoms was used. Results: The median symptom score decreased from 22 (range, 9-29) preoperatively to 4 (range, 0-16) at last follow-up, (p < 0.01). During the follow-up period, 13 patients suffered symptom recurrence; seven of them (54%) had already been diagnosed at the 1-year followup. All of these patients were treated with complementary pneumatic dilations. Overall, at a minimum of 6years after the operation, 81.7% of the patients were satisfied with the treatment and were able to eat normally. Conclusions: The long-term outcome of laparoscopic surgical treatment of esophageal achalasia is only slightly affected by the length of the follow-up and most of the symptomatic failures occur in the early period after the operation.
Very Late Results of Esophagomyotomy for Patients With Achalasia
Annals of Surgery, 2006
Introduction: Laparoscopic esophagomyotomy is the preferred approach to patients with achalasia of the esophagus, However, there are very few long-term follow-up studies (Ͼ10 years) in these patients. Objective: To perform a very late subjective and objective follow-up in a group of 67 patients submitted to esophagomyotomy plus a partial antireflux surgery (Dor's technique). Material and Methods: In a prospective study that lasted 30 years, 67 patients submitted to surgery were divided into 3 groups: group I followed for 80 to 119 months (15 patients); group II, with follow-up of 120 to 239 months (35 patients); and group III, with follow-up more than 240 months (17 patients). They were submitted to clinical questionnaire, endoscopic evaluation, histologic analysis, radiologic studies, manometric determinations, and 24-hour pH studies late after surgery. Results: Three patients developed a squamous cell esophageal carcinoma 5, 7, and 15 years after surgery. At the late follow-up, Visick III and IV were seen in 7%, 23%, and 35%, according to the length of follow-up of each group. Endoscopic examination revealed a progressive nonsignificant deterioration of esophageal mucosa, histologic analysis distal to squamous-columnar junction showed a significant decrease of fundic mucosa in patients of group III, with increase of intestinal metaplasia, although not significant time. Lower esophageal sphincter showed a significant decrease of resting pressure 1 year after surgery, which remained similar at the late control. There was no return to peristaltic activity. Acid reflux measured by 24-hour pH studies revealed a progressive increase, and the follow-up was longer. Nine patients developed Barrett esophagus: 6 of them a short-segment and 3 a long-segment Barrett esophagus. Final clinical results in all 67 patients demonstrated excellent or good results in 73% of the cases, development of epidermoid carcinoma in 4.5%, and failures in 22.4% of the patients, mainly due to reflux esophagitis. Incomplete myotomy was seen in only 1 case. Conclusion: In patients with achalasia submitted to esophagomyotomy and Dor's antireflux procedure, there is a progressive clinical deterioration of initially good results if a very long follow-up is performed (23 years after surgery), mainly due to an increase in pathologic acid reflux disease and the development of short-or long-segment Barrett esophagus.