title: Multidisciplinary Approach to Esophageal Achalasia: A Single Center Experience.
abstract: BACKGROUND
  The treatment of achalasia is palliative. Pneumatic dilatation (PD) or laparoscopic Heller myotomy (LHM) just eliminates the outflow obstruction allowing easier emptying of the esophagus. The aim of this study was to evaluate the results of a multidisciplinary approach to esophageal achalasia.
  
  
  METHODS
  A consecutive series of patients with achalasia treated by a multidisciplinary esophageal team consisting of radiologists, gastroenterologists, and surgeons in a quaternary care center between May 2008 and April 2015 were analyzed.
  
  
  RESULTS
  A total of 147 patients with achalasia underwent LHM and partial fundoplication. Sixty-two patients (42%) had been treated preoperatively with PD and/or botulinum toxin (BT). The preoperative Eckardt score (ES) was 6.4 ± 2. At a median follow-up of 22 months, 128 patients (87%) did well and required no further treatment (ES 0.1). The remaining 19 patients (13%) had recurrence of symptoms and required further treatment: 12 were treated with PD and improved (ES 0.7); 4 were treated with PD and BT and improved (ES 1.3); 3 failed PD. These 3 patients had been treated with multiple sessions of PD and BT before the myotomy. Overall, 144 patients (98%) did well with laparoscopic (87%) or laparoscopic and endoscopic treatment (11%).
  
  
  CONCLUSIONS
  The results of this study show that (a) LHM is an effective treatment modality, (b) PD improved symptoms in the majority of patients with recurrent dysphagia after myotomy and (c) multiple preoperative endoscopic treatments seem to affect outcomes of LHM. Patients with achalasia should be treated in a quaternary care center by a multidisciplinary team.
authors.affiliation: 1 Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Francisco
authors.initials: F
authors.lastname: Schlottmann
authors.affiliation: 2 Department of Surgery, University of Chicago , Chicago, Illinois.
authors.forename: Ciro
authors.initials: C
authors.lastname: Andolfi
authors.affiliation: 3 Department of Medicine, University of Chicago , Chicago, Illinois.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Kavitt
authors.affiliation: 3 Department of Medicine, University of Chicago , Chicago, Illinois.
authors.forename: Vani J A
authors.initials: VJA
authors.lastname: Konda
authors.affiliation: 1 Department of Surgery, Center for Esophageal Diseases and Swallowing, University of North Carolina , Chapel Hill, North Carolina.
authors.forename: Marco G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D003680:Deglutition Disorders / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: achalasia; laparoscopic myotomy; pneumatic dilatation