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Botox, Balloon, or Myotomy: Optimal Treatment for Achalasia

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Difficult Decisions in Thoracic Surgery

Abstract

Achalasia is a primary and profound esophageal motility disorder with an unclear etiology and which is, to date, incurable. In spite of its rare occurrence in the population (1 : 100,000), it stimulates large amounts of research and commentary by gastrointestinal (GI) physicians and surgeons, in large part due to ongoing controversy over the optimal treatment of these patients. When a nalyzing treatment options it is critical to keep in mind that all treatments are palliative in nature and are primarily aimed at relief of dysphagia and regurgitation. Normal esophageal function is almost never restored, and even a patient with an excellent result will not have completely normal swallowing.

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References

  1. Storr M, Born P, Frimberger E, et al. Treatment of achalasia: the short-term response to botulinum toxin injection seems to be independent of any kind of pretreatment. Gastroenterology 2002;2:19–27.

    PubMed  CAS  Google Scholar 

  2. Zaninotto G, Annese V, Costantini M, et al. Randomized controlled trial of botulinum toxin versus laparoscopic heller myotomy for esophageal achalasia. Ann Surg 2004;239:364–370.

    Article  PubMed  Google Scholar 

  3. Costantini M, Zaninotto G, Guirroli E, et al. The laparoscopic Heller-Dor operation remains an effective treatment for esophageal achalasia at a minimum 6-year follow-up. Surg Endosc 2005;19: 345–351.

    Article  PubMed  CAS  Google Scholar 

  4. Zaninotto G, Vergadoro V, Annese V, et al. Botulinum toxin injection versus laparoscopic myotomy for the treatment of esophageal achalasia: economic analysis of a randomized trial 43. Surg Endosc 2004;18:691–695.

    Article  PubMed  CAS  Google Scholar 

  5. Kolbasnik J, Waterfall WE, Fachnie B. Long-term efficacy of Botulinum toxin in classical achalasia. Am J Gastroenterol 1999;94:3434–3438.

    Article  PubMed  CAS  Google Scholar 

  6. Diener U, Patti MG, Molena D, et al. Laparoscopic Heller myotomy relieves dysphagia in patients with achalasia and low LES pressure following pneumatic dilatation. Surg Endosc 2001;15:687–690.

    Article  PubMed  CAS  Google Scholar 

  7. Andrews CN, Anvari M, Dobranowski J. Laparoscopic Heller’s myotomy or botulinum toxin injection for management of esophageal achalasia. Patient choice and treatment outcomes. Surg Endosc 1999;13:742–746.

    Article  PubMed  CAS  Google Scholar 

  8. Anselmino M, Zaninotto G, Costantini M, et al. One-year follow-up after laparoscopic Heller-Dor operation for esophageal achalasia. Surg Endosc 1997;11:3–7.

    Article  PubMed  CAS  Google Scholar 

  9. Patti MG, Feo CV, Arcerito M, et al. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Dig Dis Sci 1999;44:2270–2276.

    Article  PubMed  CAS  Google Scholar 

  10. Richardson WS, Willis GW, Smith JW. Evaluation of scar formation after botulinum toxin injection or forced balloon dilation to the lower esophageal sphincter. Surg Endosc 2003;17:696–698.

    Article  PubMed  CAS  Google Scholar 

  11. Csendes A, Braghetto I, Henriquez A, Cortes C. Late results of a prospective randomised study comparing forceful dilatation and oesophago myotomy in patients with achalasia. Gut 1989;30:299–304.

    PubMed  CAS  Google Scholar 

  12. Patti MG, Pellegrini CA, Arcerito M, Tong J, Mulvihill SJ, Way LW. Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders. Arch Surg 1995;130:609–615.

    PubMed  CAS  Google Scholar 

  13. Anselmino M, Perdikis G, Hinder RA, et al. Heller myotomy is superior to dilatation for the treatment of early achalasia. Arch Surg 1997;132:233–240.

    PubMed  CAS  Google Scholar 

  14. Urbach DR, Hansen PD, Khajanchee YS, Swanstrom LL. A decision analysis of the optimal initial approach to achalasia: laparoscopic Heller myotomy with partial fundoplication, thoracoscopic Heller myotomy, pneumatic dilatation, or botulinum toxin injection. J Gastrointest Surg 2001;5:192–205.

    Article  PubMed  CAS  Google Scholar 

  15. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb 1991;36:152–154.

    PubMed  CAS  Google Scholar 

  16. Dempsey DT, Kalan MM, Gerson RS, Parkman HP, Maier WP. Comparison of outcomes following open and laparoscopic esophag omyotomy for achalasia. Surg Endosc 1999;13:747–750.

    Article  PubMed  CAS  Google Scholar 

  17. Pellegrini C, Wetter LA, Patti M, et al. Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. Ann Surg 1992;216:291–296.

    Article  PubMed  CAS  Google Scholar 

  18. Patti MG, Arcerito M, Pellegrini CA. Thoracoscopic and laparoscopic Heller’s myotomy in the treatment of esophageal achalasia. Ann Chir Gynaecol 1995;84:159–164.

    PubMed  CAS  Google Scholar 

  19. Patti MG, Arcerito M, De PM, et al. Comparison of thoracoscopic and laparoscopic Heller myotomy for achalasia. J Gastrointest Surg 1998;2:561–566.

    Article  PubMed  CAS  Google Scholar 

  20. Raftopoulos Y, Landreneau RJ, Hayetian F, et al. Factors affecting quality of life after minimally invasive Heller myotomy for achalasia. J Gastrointest Surg 2004;8:233–239.

    Article  PubMed  Google Scholar 

  21. Ancona E, Anselmino M, Zaninotto G, et al. Esophageal achalasia: laparoscopic versus conventional open Heller-Dor operation. Am J Surg 1995;170:265–270.

    Article  PubMed  CAS  Google Scholar 

  22. Collard JM, Romagnoli R, Lengele B, Salizzoni M, Kestens PJ. Heller-Dor procedure for achalasia: from conventional to video-endoscopic surgery. Acta Chir Belg 1996;96:62–65.

    PubMed  CAS  Google Scholar 

  23. Douard R, Gaudric M, Chaussade S, Couturier D, Houssin D, Dousset B. Functional results after laparoscopic Heller myotomy for achalasia: A comparative study to open surgery. Surgery 2004;136:16–24.

    Article  PubMed  Google Scholar 

  24. Ramacciato G, Mercantini P, Amodio PM, et al. The laparoscopic approach with antireflux surgery is superior to the thoracoscopic approach for the treatment of esophageal achalasia. Experience of a single surgical unit. Surg Endosc 2002;16:1431–1437.

    Article  PubMed  CAS  Google Scholar 

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Swanstrom, L.L., Taylor, M.D. (2007). Botox, Balloon, or Myotomy: Optimal Treatment for Achalasia. In: Ferguson, M.K. (eds) Difficult Decisions in Thoracic Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-474-8_35

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  • DOI: https://doi.org/10.1007/978-1-84628-474-8_35

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-384-0

  • Online ISBN: 978-1-84628-474-8

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