Long-term outcome of esophageal myotomy for achalasia.
OBJECTIVE
Modified Heller's myotomy is still the first choice for achalasia and the assessment of surgical outcomes is usually made based on the subjective sensation of patients. This study was to objectively assess the long-term outcomes of esophageal myotomy for achalasia using esophageal manometry, 24-hour pH monitoring, esophageal scintigraphy and fiberoptic esophagoscopy.


METHODS
From February 1979 to October 2000, 176 patients with achalasia underwent modified Heller's myotomy, including esophageal myotomy alone in 146 patients, myotomy in combination with Gallone or Dor antireflux procedure in 22 and 8 patients, respectively. Clinical score, pressure of the lower esophageal sphincter (LES), esophageal clearance rate and gastroesophageal reflux were determined before and 1 to 22 years after surgery.


RESULTS
After a median follow-up of 14 years, 84.5% of patients had a good or excellent relief of symptoms, and clinical scores as well as resting pressures of the esophageal body and LES were reduced compared with preoperative values (P<0.001). However, there was no significant difference in DeMeester score between pre- and postoperative patients (P=0.51). Esophageal transit was improved in postoperative patients, but still slower than that in normal controls. The incidence of gastroesophageal reflux in patients who underwent esophageal myotomy alone was 63.6% compared to 27.3% in those who underwent myotomy and antireflux procedure (P=0.087). Three (1.7%) patients were complicated with esophageal cancer after surgery.


CONCLUSIONS
Esophageal myotomy for achalasia can reduce the resting pressures of the esophageal body and LES and improve esophageal transit and dysphagia. Myotomy in combination with antireflux procedure can prevent gastroesophageal reflux to a certain extent, but further randomized studies should be carried out to demonstrate its efficacy.
Liu
Jun-Feng
JF
Department of Thoracic Surgery, Fourth Hospital, Hebei Medical University, Shijiazhuang 050011, Hebei Province, China. liujf@heinfo.net
Zhang
Jun
J
Tian
Zi-Qiang
ZQ
Wang
Qi-Zhang
QZ
Li
Bao-Qing
BQ
Wang
Fu-Shun
FS
Cao
Fu-Min
FM
Zhang
Yue-Feng
YF
Li
Yong
Y
Fan
Zhao
Z
Han
Jian-Jing
JJ
Liu
Hui
H
D000293:Adolescent; D000328:Adult; D002648:Child; D002681:China; D013505:Digestive System Surgical Procedures; D004931:Esophageal Achalasia / Q000000981:diagnostic imaging / Q000601:surgery*; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011877:Radionuclide Imaging; D016896:Treatment Outcome