title: Evaluation of outcome after cardiomyotomy for achalasia using the Chicago classification.
abstract: BACKGROUND
  Achalasia can be subdivided into manometric subtypes according to the Chicago classification. These subtypes are proposed to predict outcome after treatment. This hypothesis was tested using a database of patients who underwent laparoscopic Heller's cardiomyotomy with anterior fundoplication.
  
  
  METHODS
  All patients who underwent Heller's cardiomyotomy for achalasia between June 1993 and March 2015 were identified from an institutional database. Manometry tracings were retrieved and re-reported according the Chicago classification. Outcome was assessed by a postal questionnaire, and designated a success if the modified Eckardt score was 3 or less, and the patient had not undergone subsequent surgery or pneumatic dilatation. Difference in outcome after cardiomyotomy was analysed with a mixed-effects logistic regression model.
  
  
  RESULTS
  Sixty, 111 and 24 patients had type I, II and II achalasia respectively. Patients with type III achalasia were more likely to be older than those with type I or II (mean age 63 versus 50 and 49 years respectively; P = 0·001). Some 176 of 195 patients returned questionnaires after surgery. Type III achalasia was less likely to have a successful outcome than type II (odds ratio (OR) 0·38, 95 per cent c.i. 0·15 to 0·94; P = 0·035). There was no significant difference in outcome between types I and II achalasia (II versus I: OR 0·87, 0·47 to 1·60; P 0·663). The success rate at 3-year follow-up was 69 per cent (22 of 32) for type I, 66 per cent (33 of 50) for type II and 31 per cent (4 of 13) for type III.
  
  
  CONCLUSIONS
  Type III achalasia is a predictor of poor outcome after cardiomyotomy. There was no difference in outcome between types I and II achalasia.
authors.affiliation: Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia.|Disciplines of Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: P W
authors.initials: PW
authors.lastname: Hamer
authors.affiliation: Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia.|Disciplines of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: R H
authors.initials: RH
authors.lastname: Holloway
authors.affiliation: Oesophageal Function Laboratory, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Heddle
authors.affiliation: Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia.|Disciplines of Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: P G
authors.initials: PG
authors.lastname: Devitt
authors.affiliation: Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia.|Disciplines of Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Kiroff
authors.affiliation: Oesophageal Function Laboratory, Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Burgstad
authors.affiliation: Professorial Unit of Oesophagogastric Surgery, Royal Adelaide Hospital, Adelaide, Australia.|Disciplines of Surgery, University of Adelaide, Adelaide, Australia.
authors.forename: S K
authors.initials: SK
authors.lastname: Thompson
mesh_terms: D004931:Esophageal Achalasia / Q000503:physiopathology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008365:Manometry / Q000379:methods; D008875:Middle Aged; D016896:Treatment Outcome