Effects of Pneumatic Dilation and Myotomy on Esophageal Function and Morphology in Patients with Achalasia

Gockel, Ines; Juginger, Theodor; Eckardt, Volker F.
February 2005
American Surgeon;Feb2005, Vol. 71 Issue 2, p128
Academic Journal
Only two treatment modalities--pneumatic dilation and Heller myotomy--promise long-term relief from dysphagia and regurgitation in patients with achalasia. The objective of this study was to determine whether both options differ in their effects on esophageal function, morphology, and improvement in symptoms. Eighty-nine patients diagnosed with achalasia between January 1980 and December 2002 at a single center were enrolled in this study. Sixty-four patients under-went pneumatic dilation and 25 Heller myotomy in combination with an anterior semifundoplication (Dor procedure). Clinical evaluation (Eckardt-Score), esophageal manometry, and barium swallow were performed before and within 6 months after treatment. Our data shows that Heller myotomy reduces the LES resting pressure more markedly (7.9 [3.7-16.9] mm Hg) than pneumatic dilation (14.5 [2.7-36.0] mm Hg) (P < 0.0001) with similar pressures at diagnosis in both groups. Morphologic changes, assessed by the diameter of the esophageal corpus, were also more pronounced after surgical therapy (P > 0.05). Both options will lead to an immediate and significant improvement in symptoms, although the two treatment modalities did not differ in their subjective results. As only objective findings, such as those obtained by manometry and the timed barium swallow, have proven relevance for the assessment of long-term results, surgical therapy is the superior and more effective treatment option in patients with achalasia.


Related Articles

  • Fixed Corkscrew Pattern of the Esophagus. Hodes, Steven E.; Korsten, Mark A. // American Journal of Gastroenterology;Mar1980, Vol. 73 Issue 3, p249 

    The radiographic, manometric and endoscopic evaluation of an alcoholic patient with dysphagia, a mid esophageal diverticulum and "corkscrewing" of the distal esophagus is reported. The patient displayed a constant deformity of the distal esophagus which was associated with progressive but...

  • Transient esophageal obstruction in a young man: An intramural esophageal hematoma? Lauzon, S. C.; Heitmiller, R. F. // Diseases of the Esophagus;Apr2005, Vol. 18 Issue 2, p127 

    We present a case of a 20-year-old, previously healthy, male student who presented with dysphagia secondary to mechanical esophageal obstruction that resolved spontaneously. Although our patient did not have ‘classic’ patient characteristics, we believe that the clinical evidence...

  • Return of Esophageal Peristalsis after Nifedipine Therapy in Patients with Idiopathic Esophageal Achalasia. Coccia, G.; Bortolotti, M.; Michetti, P.; Dodero, M. // American Journal of Gastroenterology;Dec1992, Vol. 87 Issue 12, p1705 

    This study was carried out to demonstrate the possible return of esophageal peristalsis in patients affected by esophageal achalasia chronically treated with sublingual nifedipine and to investigate which parameters are correlated with the return of peristalsis. Thirty-two patients were treated...

  • The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. Sweet, Matthew P.; Nipomnick, Ian; Gasper, Warren J.; Bagatelos, Karen; Ostroff, James W.; Fisichella, Piero M.; Way, Lawrence W.; Patti, Marco G. // Journal of Gastrointestinal Surgery;Jan2008, Vol. 12 Issue 1, p159 

    In the past, a Heller myotomy was considered to be ineffective in patients with achalasia and a markedly dilated or sigmoid-shaped esophagus. Esophagectomy was the standard treatment. The aims of this study were (a) to evaluate the results of laparoscopic Heller myotomy and Dor fundoplication in...

  • Percutaneous Endoscopic Gastrostomy as a Tool to Assist Pneumatic Dilation in a Difficult Case of Sigmoid Esophagus. Michopoulos, Spyros; Stamatis, Georgios; Karagiannis, Stephanos; Dimopoulos, Fotis; Archavlis, Emmanouel; Archimandritis, Athanasios J // American Journal of Gastroenterology;Apr2006, Vol. 101 Issue 4, p902 

    We describe a case of a long-standing, untreated achalasia with a huge sigmoid esophagus in a 58-year-old Caucasian man who declined surgery. All means of classical endoscopic approach for pneumatic dilation, including the use of an overtube, were impossible because any attempt to propel the...

  • Self-expanding metal stents in the palliation of malignant dysphagia: Outcome analysis in 100 consecutive patients. Elphick, D. A.; Smith, B. A.; Bagshaw, J.; Riley, S. A. // Diseases of the Esophagus;Apr2005, Vol. 18 Issue 2, p93 

    Patients with inoperable esophageal malignancy often undergo palliative self-expanding metal stent insertion. This analysis of cases shows that although such stents provide good palliation of dysphagia, complications frequently occur. Complications reported were pain after insertion, bleeding,...

  • Pseudoachalasia of the cardia: a review. Robertson, C. S.; Griffith, C. D. M.; Atkinson, M.; Hardcastle, J. D. // Journal of the Royal Society of Medicine;Jul1988, Vol. 81 Issue 7, p399 

    The article presents a study which discussed the pseudoachalasia of the cardia. The authors concluded that pseudoachalasia in its early stages, is likely to be mistaken for true achalasia. Although obstruction by the growth itself is the usual cause of dysphagia, degenerative changes in the...

  • Esophageal Disease in Patients with Angina-like Chest Pain. Kline, M.; Chesne, R.; Sturdevant, R. A. L.; McCallum, R. W. // American Journal of Gastroenterology;Feb1981, Vol. 75 Issue 2, p116 

    To assess the frequency of esophageal disease in patients with angina-like chest pain and normal coronary arteriograms, 16 patients underwent esophageal manometric studies, acid perfusion (Bernstein) tests, upper gastrointestinal series and cholecystograms. Five patients had evidence of...

  • Results of laparoscopic Heller-Toupet operation for achalasia. Perrone, J. M.; Frisella, M. M.; Desai, K. M.; Soper, N. J. // Surgical Endoscopy;Nov2004, Vol. 18 Issue 11, p1565 

    Background: Laparoscopic myotomy has become the preferred treatment for achalasia. Controversy persists on the need for fundoplication and/or its type; when used, most series have utilized the Dor fundoplication. We report a large series of laparoscopic Heller­Toupet procedures. Methods: All...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics