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Minimally Invasive Treatment of Esophageal Achalasia

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Illustrative Handbook of General Surgery

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Abstract

Achalasia is a rare neurodegenerative disease of the esophagus and the lower esophageal sphincter characterized by the inability of the lower esophageal sphincter to relax and by failure of esophageal body peristalsis, most commonly resulting in dysphagia. Current treatment options are directed at palliation of symptoms. Therapies include pharmacological, endoscopic and surgical therapy. Endoscopic dilation was the first line of therapy until the introduction of minimally invasive surgical techniques in the early 1990s that paved the way for the introduction of laparoscopic myotomy. Laparoscopic Heller myotomy with partial fundoplication performed at an experienced center is currently the first line of therapy because it offers a low complication rate, the most durable symptom relief, and the lowest incidence of postoperative gastro-esophageal reflux.

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References

  1. Campos GM, Vittinghoff E, Rabl C, et al. Endoscopic and surgical treatments for achalasia: a systematic review and meta-analysis. Ann Surg. 2009;249(1):45–57.

    Article  PubMed  Google Scholar 

  2. Nguyen NQ, Holloway RH. Recent developments in esophageal motor disorders. Curr Opin Gastroenterol. 2005;21(4):478–84.

    PubMed  Google Scholar 

  3. Howard PJ, Maher L, Pryde A, Cameron EW, Heading RC. Five year prospective study of the incidence, clinical features, and diagnosis of achalasia in Edinburgh. Gut. 1992;33(8):1011–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Ruffato A, Mattioli S, Lugaresi ML, D’Ovidio F, Antonacci F, Di Simone MP. Long-term results after Heller-Dor operation for oesophageal achalasia. Eur J Cardiothorac Surg. 2006;29(6):914–9.

    Article  PubMed  Google Scholar 

  5. O’Neill OM, Johnston BT, Coleman HG. Achalasia: a review of clinical diagnosis, epidemiology, treatment and outcomes. World J Gastroenterol. 2013;19(35):5806–12.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Balaji NS, Peters JH. Minimally invasive surgery for esophageal motility disorders. Surg Clin North Am. 2002;82(4):763–82.

    Article  PubMed  Google Scholar 

  7. Kraichely RE, Farrugia G. Achalasia: physiology and etiopathogenesis. Dis Esophagus. 2006;19(4):213–23.

    Article  CAS  PubMed  Google Scholar 

  8. Gockel I, Bohl JR, Junginger T. Achalasia: new insights in pathogenesis. Am J Gastroenterol. 2006;101(1):202–3.

    Article  PubMed  Google Scholar 

  9. Dogan I, Mittal RK. Esophageal motor disorders: recent advances. Curr Opin Gastroenterol. 2006;22(4):417–22.

    Article  PubMed  Google Scholar 

  10. Bennett JR, Hendrix TR. Treatment of achalasia with pneumatic dilatation. Mod Treat. 1970;7(6):1217–28.

    CAS  PubMed  Google Scholar 

  11. Roll GR, Rabl C, Ciovica R, Peeva S, Campos GM. A controversy that has been tough to swallow: is the treatment of achalasia now digested? J Gastrointest Surg. 2010;14 Suppl 1:S33–45.

    Article  PubMed  Google Scholar 

  12. Bonatti H, Hinder RA, Klocker J, et al. Long-term results of laparoscopic Heller myotomy with partial fundoplication for the treatment of achalasia. Am J Surg. 2005;190(6):874–8.

    Article  PubMed  Google Scholar 

  13. Rosemurgy A, Villadolid D, Thometz D, et al. Laparoscopic Heller myotomy provides durable relief from achalasia and salvages failures after botox or dilation. Ann Surg. 2005;241(5):725–33; discussion 33–5.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Frantzides CT, Moore RE, Carlson MA, et al. Minimally invasive surgery for achalasia: a 10-year experience. J Gastrointest Surg. 2004;8(1):18–23.

    Article  PubMed  Google Scholar 

  15. Zaninotto G, Costantini M, Molena D, et al. Treatment of esophageal achalasia with laparoscopic Heller myotomy and Dor partial anterior fundoplication: prospective evaluation of 100 consecutive patients. J Gastrointest Surg. 2000;4(3):282–9.

    Article  CAS  PubMed  Google Scholar 

  16. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg. 2003;138(5):490–5; discussion 5–7.

    Article  PubMed  Google Scholar 

  17. Patti MG, Fisichella PM, Perretta S, et al. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg. 2003;196(5):698–703; discussion −5.

    Article  PubMed  Google Scholar 

  18. Deb S, Deschamps C, Allen MS, et al. Laparoscopic esophageal myotomy for achalasia: factors affecting functional results. Ann Thorac Surg. 2005;80(4):1191–4; discussion 4–5.

    Article  PubMed  Google Scholar 

  19. Ackroyd R, Watson DI, Devitt PG, Jamieson GG. Laparoscopic cardiomyotomy and anterior partial fundoplication for achalasia. Surg Endosc. 2001;15(7):683–6.

    Article  CAS  PubMed  Google Scholar 

  20. Boeckxstaens GE, Zaninotto G, Richter JE. Achalasia. Lancet. 2014;383(9911):83–93.

    Article  PubMed  Google Scholar 

  21. Pandolfino JE, Kahrilas PJ. AGA technical review on the clinical use of esophageal manometry. Gastroenterology. 2005;128(1):209–24.

    Article  PubMed  Google Scholar 

  22. Camacho-Lobato L, Katz PO, Eveland J, Vela M, Castell DO. Vigorous achalasia: original description requires minor change. J Clin Gastroenterol. 2001;33(5):375–7.

    Article  CAS  PubMed  Google Scholar 

  23. Hoogerwerf WA, Pasricha PJ. Pharmacologic therapy in treating achalasia. Gastrointest Endosc Clin N Am. 2001;11(2):311–24, vii.

    CAS  PubMed  Google Scholar 

  24. Wen ZH, Gardener E, Wang YP. Nitrates for achalasia. Cochrane Database Syst Rev. 2004;1, CD002299.

    PubMed  Google Scholar 

  25. Wong RK, Maydonovitch C, Garcia JE, Johnson LF, Castell DO. The effect of terbutaline sulfate, nitroglycerin, and aminophylline on lower esophageal sphincter pressure and radionuclide esophageal emptying in patients with achalasia. J Clin Gastroenterol. 1987;9(4):386–9.

    Article  CAS  PubMed  Google Scholar 

  26. DiMarino Jr AJ, Cohen S. Effect of an oral beta2-adrenergic agonist on lower esophageal sphincter pressure in normals and in patients with achalasia. Dig Dis Sci. 1982;27(12):1063–6.

    Article  PubMed  Google Scholar 

  27. Marzio L, Grossi L, DeLaurentiis MF, Cennamo L, Lapenna D, Cuccurullo F. Effect of cimetropium bromide on esophageal motility and transit in patients affected by primary achalasia. Dig Dis Sci. 1994;39(7):1389–94.

    Article  CAS  PubMed  Google Scholar 

  28. Penagini R, Bartesaghi B, Negri G, Bianchi PA. Effect of loperamide on lower oesophageal sphincter pressure in idiopathic achalasia. Scand J Gastroenterol. 1994;29(12):1057–60.

    Article  CAS  PubMed  Google Scholar 

  29. Torres-Villalobos G, Martin-Del-Campo LA. Surgical treatment for achalasia of the esophagus: laparoscopic heller myotomy. Gastroenterol Res Pract. 2013;2013:708327.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Roberts KE, Duffy AJ, Bell RL. Controversies in the treatment of gastroesophageal reflux and achalasia. World J Gastroenterol. 2006;12(20):3155–61.

    PubMed Central  PubMed  Google Scholar 

  31. Annese V, Bassotti G, Coccia G, et al. A multicentre randomised study of intrasphincteric botulinum toxin in patients with oesophageal achalasia. GISMAD Achalasia Study Group Gut. 2000;46(5):597–600.

    CAS  Google Scholar 

  32. Pasricha PJ, Rai R, Ravich WJ, Hendrix TR, Kalloo AN. Botulinum toxin for achalasia: long-term outcome and predictors of response. Gastroenterology. 1996;110(5):1410–5.

    Article  CAS  PubMed  Google Scholar 

  33. Fishman VM, Parkman HP, Schiano TD, et al. Symptomatic improvement in achalasia after botulinum toxin injection of the lower esophageal sphincter. Am J Gastroenterol. 1996;91(9):1724–30.

    CAS  PubMed  Google Scholar 

  34. Annese V, Basciani M, Perri F, et al. Controlled trial of botulinum toxin injection versus placebo and pneumatic dilation in achalasia. Gastroenterology. 1996;111(6):1418–24.

    Article  CAS  PubMed  Google Scholar 

  35. Morino M, Rebecchi F, Festa V, Garrone C. Preoperative pneumatic dilatation represents a risk factor for laparoscopic Heller myotomy. Surg Endosc. 1997;11(4):359–61.

    Article  CAS  PubMed  Google Scholar 

  36. Portale G, Costantini M, Rizzetto C, et al. Long-term outcome of laparoscopic Heller-Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg. 2005;9(9):1332–9.

    Article  PubMed  Google Scholar 

  37. Boeckxstaens GE, Annese V, des Varannes SB, et al. Pneumatic dilation versus laparoscopic Heller’s myotomy for idiopathic achalasia. N Engl J Med. 2011;364(19):1807–16.

    Article  CAS  PubMed  Google Scholar 

  38. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than heller myotomy alone. Ann Surg. 2006;243(5):579–84; discussion 84–6.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Chuah SK, Chiu CH, Tai WC, et al. Current status in the treatment options for esophageal achalasia. World J Gastroenterol. 2013;19(33):5421–9.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Bello B, Herbella FA, Patti MG. Evolution of the minimally invasive treatment of esophageal achalasia. World J Surg. 2011;35(7):1442–6.

    Article  PubMed  Google Scholar 

  41. Von Renteln D, Fuchs KH, Fockens P, et al. Peroral endoscopic myotomy for the treatment of achalasia: an international prospective multicenter study. Gastroenterology. 2013;145(2), e1–3.

    Google Scholar 

  42. Inoue H, Minami H, Kobayashi Y, et al. Peroral endoscopic myotomy (POEM) for esophageal achalasia. Endoscopy. 2010;42(4):265–71.

    Article  CAS  PubMed  Google Scholar 

  43. Swanstrom LL, Kurian A, Dunst CM, Sharata A, Bhayani N, Rieder E. Long-term outcomes of an endoscopic myotomy for achalasia: the POEM procedure. Ann Surg. 2012;256(4):659–67.

    Article  PubMed  Google Scholar 

  44. Heller E. Extramukose Cardiaplastik beim chronischen Cardiospasmus mit Dilatation des Osophagus. Mitt Grenzgeb Med Chir. 1914;27:141–9.

    Google Scholar 

  45. Zaaijer JH. Cardiospasm in the aged. Ann Surg. 1923;77(5):615–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Shimi S, Nathanson LK, Cuschieri A. Laparoscopic cardiomyotomy for achalasia. J R Coll Surg Edinb. 1991;36(3):152–4.

    CAS  PubMed  Google Scholar 

  47. Campos G, Ciovica R, Takata M. Laparoscopic myotomie. Oper Tech Gen Surg. 2006;8:161–9.

    Article  Google Scholar 

  48. Lyass S, Thoman D, Steiner JP, Phillips E. Current status of an antireflux procedure in laparoscopic Heller myotomy. Surg Endosc. 2003;17(4):554–8.

    Article  CAS  PubMed  Google Scholar 

  49. Avtan L, Avci C, Guvenc H, Igci A, Ozmen V. Laparoscopic myotomy for oesophageal achalasia–adding an antireflux procedure is not always necessary. Int J Clin Pract. 2005;59(1):35–8.

    Article  CAS  PubMed  Google Scholar 

  50. Ramacciato G, D’Angelo FA, Aurello P, et al. Laparoscopic Heller myotomy with or without partial fundoplication: a matter of debate. World J Gastroenterol. 2005;11(10):1558–61.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia: long-term results. Ann Surg. 2008;248(6):1023–30.

    Article  PubMed  Google Scholar 

  52. Clemente G. The choice of fundoplication after myotomy for achalasia. Arch Surg. 2006;141(6):612, author reply −3.

    Article  PubMed  Google Scholar 

  53. Iqbal A, Haider M, Desai K, et al. Technique and follow-up of minimally invasive Heller myotomy for achalasia. Surg Endosc. 2006;20(3):394–401.

    Article  CAS  PubMed  Google Scholar 

  54. Topart P, Deschamps C, Taillefer R, Duranceau A. Long-term effect of total fundoplication on the myotomized esophagus. Ann Thorac Surg. 1992;54(6):1046–51; discussion 51–2.

    Article  CAS  PubMed  Google Scholar 

  55. Falkenback D, Johansson J, Oberg S, et al. Heller’s esophagomyotomy with or without a 360 degrees floppy Nissen fundoplication for achalasia. Long-term results from a prospective randomized study. Dis Esophagus. 2003;16(4):284–90.

    Article  CAS  PubMed  Google Scholar 

  56. Perrone JM, Frisella MM, Desai KM, Soper NJ. Results of laparoscopic Heller-Toupet operation for achalasia. Surg Endosc. 2004;18(11):1565–71.

    Article  CAS  PubMed  Google Scholar 

  57. Dobashi Y, Goseki N, Inutake Y, Kawano T, Endou M, Nemoto T. Giant epiphrenic diverticulum with achalasia occurring 20 years after Heller’s operation. J Gastroenterol. 1996;31(6):844–7.

    Article  CAS  PubMed  Google Scholar 

  58. Raiser F, Perdikis G, Hinder RA, et al. Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures. Arch Surg. 1996;131(6):593–7; discussion 7–8.

    Article  CAS  PubMed  Google Scholar 

  59. Mineo TC, Pompeo E. Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg. 2004;128(3):402–7.

    Article  PubMed  Google Scholar 

  60. Sweet MP, Nipomnick I, Gasper WJ, et al. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg. 2008;12(1):159–65.

    Article  PubMed  Google Scholar 

  61. 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(2):192–205.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Paracelsus Medical University Salzburg, Muellner Hauptstrasse 48, Salzburg, 5020, Austria

    Charlotte Rabl MD, FACS

  2. Division of Bariatric and Gastrointestinal Surgery, Department of Surgery, Virginia Commonwealth University, 1200 East Broad Street, 980519, Richmond, Virginia, 23298, USA

    Guilherme M. Campos MD, FACS

Authors
  1. Charlotte Rabl MD, FACS
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  2. Guilherme M. Campos MD, FACS
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Correspondence to Guilherme M. Campos MD, FACS .

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Editors and Affiliations

  1. University of Wisconsin, Madison, Wisconsin, USA

    Herbert Chen

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Rabl, C., Campos, G.M. (2016). Minimally Invasive Treatment of Esophageal Achalasia. In: Chen, H. (eds) Illustrative Handbook of General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-24557-7_14

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  • DOI: https://doi.org/10.1007/978-3-319-24557-7_14

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