title: Preoperative intervention does not affect esophageal muscle histology or patient outcomes in patients undergoing laparoscopic Heller myotomy.
abstract: Botox injection and pneumatic dilation are common therapies for achalasia. We sought to determine the impact of these preoperative therapies on esophageal muscle histology and outcomes after laparoscopic Heller myotomy. A total of 73 consecutive patients had esophageal muscle biopsies taken from the gastroesophageal junction at the time of myotomy between November 1998 and November 2001. Muscle fibrosis was graded by a senior pathologist who was blinded to preoperative treatments and postoperative outcomes. Patients graded their dysphagia and heartburn symptoms before and after myotomy and graded their outcomes at follow-up. Patients were grouped according to the preoperative endoscopic treatment (dilation, Botox, both, or neither) and the groups were compared. Preoperative therapy did not correlate with esophageal fibrosis or postoperative outcomes, and the degree of esophageal muscle fibrosis was not predictive of outcome. Symptom scores improved significantly for dysphagia (4.5 +/- 0.9 vs. 1.6 +/- 1.6) and heartburn (2.3 +/- 1.8 vs. 1.5 +/- 1.4) irrespective of preoperative therapy or fibrosis. Overall, excellent or good outcomes were obtained in 92% of patients at follow-up of 15.7 months +/- 14.4. Successful outcomes are highly probable after laparoscopic Heller myotomy regardless of preoperative interventions. The amount of fibrosis in the esophageal muscle is not related to preoperative intervention and is not predictive of outcomes.
authors.affiliation: Department of Surgery, Joy McCann Culverhouse Center for Swallowing Disorders, University of South Florida College of Medicine, Tampa, FL 33601, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Bloomston
authors.forename: Elie
authors.initials: E
authors.lastname: Fraiji
authors.forename: H Worth
authors.initials: HW
authors.lastname: Boyce
authors.forename: Amerigo
authors.initials: A
authors.lastname: Gonzalvo
authors.forename: Milton
authors.initials: M
authors.lastname: Johnson
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D016022:Case-Control Studies; D002404:Catheterization / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004931:Esophageal Achalasia / Q000175:diagnosis / Q000601:surgery*; D004943:Esophagogastric Junction / Q000473:pathology* / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology / Q000601:surgery; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D019274:Botulinum Toxins, Type A