Effect of laparoscopic esophagomyotomy on chest pain associated with achalasia and prediction of therapeutic outcomes.
BACKGROUND
The effect of myotomy for achalasia on chest pain has not been clarified. The current study aimed to investigate the therapeutic effect of laparoscopic myotomy on chest pain associated with achalasia and to identify prognostic factors for outcomes.


METHODS
Between March 2005 and September 2008, 95 patients were available for detailed interviews and for assessment of clearance by timed barium esophagogram (TBE) before and after surgery. Of the 95 patients, 47 (24 men; mean age, 42.9 ± 13.5 years) who experienced chest pain before surgery were studied. The subjects were asked in detail about dysphagia and chest pain before surgery and 6 months after surgery. The frequency and severity of the symptoms were graded on a scale of 0 to 4. In addition, the values obtained by multiplying the grade for frequency by the grades for severity of the two symptoms were defined as the dysphagia score and the chest pain score, respectively. The patients with chest pain scores of 0 after surgery were defined as group A and those with scores smaller than their preoperative scores as group B. The remaining patients with other scores were defined as group C. The background factors and clinical conditions of the three groups were compared.


RESULTS
The mean chest pain score decreased from 5.0 ± 3.2 to 1.0 ± 1.6 (p < 0.001). The score after surgery was 0 for 27 patients and showed a decrease for 15 patients. Although the three groups did not differ in their characteristics, differences were noted in postoperative TBE factors (i.e., groups A and B had significantly shorter barium columns than group C at 1 and 5 min after surgery (p = 0.001).


CONCLUSIONS
Laparoscopic myotomy had a therapeutic effect on chest pain associated with achalasia, and improvement in postoperative esophageal clearance may influence the therapeutic effect.
Omura
Nobuo
N
Department of Surgery, Jikei University School of Medicine, 3-25-8, Nishishinbashi, Minato-ku, Tokyo 105-8461, Japan. surgomura@jikei.ac.jp
Kashiwagi
Hideyuki
H
Yano
Fumiaki
F
Tsuboi
Kazuto
K
Ishibashi
Yoshio
Y
Hoshino
Masato
M
Yanaga
Katsuhiko
K
D000328:Adult; D001466:Barium Sulfate; D002637:Chest Pain / Q000209:etiology / Q000628:therapy*; D003287:Contrast Media; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D004947:Esophagus / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011859:Radiography; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
D003287:Contrast Media; D001466:Barium Sulfate