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Query: UMLS:C0014848 (achalasia)
 2,804 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Long-term results of operative treatment of cardiospasm and megaoesophagus in 111 patients are presented. There were 67 women and 44 men treated, age 4 to 65. The authors have for several years used their own, in this Department developed method of operation for cardiospasm, which joins Heller's operation with the reconstruction of the cardia to prevent reflux. In very advanced stages of the disease as megaoesophagus they use an original surgical procedure, which consists in connecting the thoracic segment of the oesophagus with the prepyloric part of the stomach by means of a pedicle jejunal graft. Clinical follow-up supported by x-ray examination and endoscopy has shown very good results of such treatment.
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PMID:Surgical treatment of cardiospasm and megaoesophagus. 141 Dec 40

A female aged 46, with achalasia cardia had no relief of dysphagia after pneumatic dilatation done twice. At surgery the muscle fibres were found disrupted, with submucosal adhesions and friable mucosa. Heller's cardiomyotomy could not be done. Repair similar to Mickulicz pyloroplasty was done.
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PMID:Heller's cardiomyotomy after failed pneumatic dilatation for achalasia cardia--operative pitfalls. 141 95

The authors treated 17 patients with achalasia by a thoracoscopic (15 patients) or laparoscopic (2 patients) Heller myotomy. All patients had dysphagia and an upper gastrointestinal series demonstrating a dilated esophagus with a bird-beak deformity at the cardia. Manometry showed a mean lower esophageal sphincter (LES) pressure of 32 +/- 4 mmHg, incomplete sphincter relaxation on swallowing, and no primary esophageal peristalsis. After operation, mean LES pressure was 10 +/- 2 mmHg. Fifteen patients were fed on the second postoperative day. The average hospital stay was 3 days, and there were no deaths or major complications. In three early patients, the myotomy was not carried far enough onto the stomach, and dysphagia persisted until a second myotomy was performed (laparoscopically in two patients). The authors found that having an endoscope in the esophagus during the operation facilitated exposure and was vital to determine the appropriate length of the myotomy. With regard to dysphagia, final results were excellent in 12 patients (70%), good in two patients (12%), fair in two patients (12%), and poor in one patient (6%). Heller myotomy can be safely and reliably performed with minimally invasive techniques. Dysphagia is relieved, postoperative pain is minimal, hospital stay is short, and the patient can return quickly to normal activity.
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PMID:Thoracoscopic esophagomyotomy. Initial experience with a new approach for the treatment of achalasia. 141 78

Sixty-four patients with achalasia of the esophagus were surgically treated during the period 1973-1990. They were analyzed a late follow-up (mean = 78 months) by means of subjective and objective parameters. The Authors emphasize the efficiency of the diagnostic approach so that surgical treatment offers better results. The surgical technique of choice consists of an anterior esophagomyotomy (extending from 6 cm above the esophagogastric junction down to 1-2 cm below it) with the addition of an anterior Dor antireflux procedure through a laparotomy. The other therapeutic approach to achalasia is pneumatic dilatation of lower esophageal sphincter. A retrospective comparison of two different treatments is made through the analysis of the literature (medlars 1986-1990). Relief of dysphagia is reported in 92.78% of patients treated by myotomy and in 78.71% of those treated by forceful dilatation. The morbidity rate is greater after pneumatic dilatation (6% vs 5%) and the mortality rate is 1.1% after myotomy and 0.2% after dilatation. There are not rigorous criteria of choice between the two treatment methods but the Authors indicate that Heller's myotomy with an antireflux procedure achieve better and lasting results.
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PMID:[Esophageal achalasia: cardiomyotomy or pneumatic dilatation?]. 146 13

Ambulatory non-perfused oesophageal manometry was used to study oesophageal body function during consumption of a full meal in patients with achalasia. A measure of oesophageal body activity (the meal area index) was developed by calculating the total area under the pressure curve during eating, above the preprandial baseline oesophageal pressure, per meal minute. Untreated patients with achalasia (n = 13) were compared with normal subjects (n = 42), patients with benign stricture (n = 9) and patients with achalasia who had undergone Heller's myotomy (n = 17). The results showed a high meal area index in achalasia, due to a rise in baseline oesophageal pressure and frequent high-amplitude contractions during eating. This was not seen in normal subjects or patients with stricture. The high meal area index was abolished by successful Heller's myotomy but remained in two patients with persisting dysphagia. Sustained high intraoesophageal pressure is generated during consumption of a solid meal in untreated achalasia, resulting in a unique manometric profile. Manometry during eating using the meal area index permits quantitative assessment of oesophageal body function in achalasia and may aid in the assessment of response to treatment.
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PMID:Meal area index: a new technique for quantitative assessment in achalasia by ambulatory manometry during eating. 146 93

From 1976 to 1989, 206 patients referred for primary treatment of esophageal achalasia underwent transabdominal Heller's myotomy and anterior fundoplication according to the Dor technique. In the majority of the patients, the cardia was not mobilized, and the myotomy was extended in length for about 10 cm (8 cm on the esophagus and 2 cm on the stomach). There was no operative mortality. Two patients (0.9%) required reoperation due to bleeding from the myotomy site in one and leakage from the gastrotomy site in the other. One hundred ninety-three patients entered the follow-up study and were followed up from 12 to 144 months (median, 64.5 months). Five patients died during the follow-up of unrelated diseases, and in one patient, an esophageal cancer infiltrating the trachea was discovered 26 months after the operation. Clinical results were excellent or good in 93.8% of the patients, and fair in 2.6%. Disabling dysphagia recurred in seven patients (3.6%), six of whom required pneumatic dilation for relief and one patient who underwent reoperation because of a paraesophageal hiatal hernia. Postoperative roentgenographic studies showed a significant reduction in the mean value of the maximal esophageal diameter. Esophageal manometry showed a significant reduction of lower esophageal sphincter pressure and length over preoperative values. Twenty-four-hour esophageal pH monitoring showed an abnormal acid exposure in seven (8.6%) of 81 patients tested. Of these patients, one had erosive esophagitis on endoscopy. Esophageal transit scintigraphy, performed in 11 patients, showed a significant improvement of transit time in the erect position compared with preoperative values. We concluded that transabdominal esophagomyotomy combined with Dor fundoplication is a safe, effective, and durable procedure in the treatment of esophageal achalasia.
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PMID:Primary treatment of esophageal achalasia. Long-term results of myotomy and Dor fundoplication. 154 Jan 2

A 42 year old woman had undergone a Heller myotomy for achalasia of the cardia at age 28. Thereafter, she had become asymptomatic but reported for endoscopic follow-up examinations at three-yearly intervals. Fourteen years after surgery, endoscopy and biopsy revealed "carcinoma in situ" in the proximal esophagus and surgery was recommended. In the resected specimen, a circumscribed area of cancer was demonstrated that invaded the lamina propria but was confined to the mucosa. With the exception of mild and transient postoperative dysphagia, she had an uneventful postoperative course and remains well 16 months following surgery. This case demonstrates that endoscopic surveillance may detect early malignant changes in the achalasic esophagus and may possibly lead to an improvement in survival.
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PMID:Superficial esophageal carcinoma in achalasia, detected by endoscopic surveillance. 163 73

Modified Heller's myotomy for achalasia of the esophagus was performed via a left thoracotomy in 34 cases (group A) and via an upper midline abdominal incision in 30 (group B). There were no perioperative deaths. Complications arose in ten cases. After follow-up averaging 13 years (range 3-24 years) 4% of the group A patients reported dysphagia for solids, but none for liquids, and in group B the corresponding figures were 52% and 26%. Reflux symptoms were present in 30% of the group A and 60% of the group B cases, and the respective incidence of microscopic esophagitis was 30% and 43%. There were three esophageal strictures, all in group B, and three cases of Barrett's epithelium, all in group A. Because of the high incidence of esophagitis and its complications following esophagomyotomy for achalasia, yearly endoscopy with biopsy and brush cytology is recommended. When myotomy is performed, an antireflux operation should be added.
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PMID:Esophagocardiomyotomy for achalasia. Long-term clinical and endoscopic evaluation of transabdominal vs. transthoracic approach. 168 19

The records of 30 patients treated for oesophageal achalasia between 1976 and 1988 were analysed retrospectively. Early and late results were collected to compare the safety and efficacy of Heller's myotomy (n = 13) and pneumatic dilatation (n = 17). Unsatisfactory immediate postoperative results were found in 4 of 13 of the patients who had undergone myotomy (31%) and in 4 of the 17 patients treated by pneumatic dilatation (24%). More patients had improved swallowing during the first postoperative year after myotomy, but this difference ceased with time. The severity of the symptoms affected the results, and dilatations that had to be repeated more than twice were ineffective. We conclude that pneumatic dilatation is as safe as Heller's myotomy, and that although the early results are significantly better after myotomy, the late results are similar.
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PMID:Heller's cardiomyotomy compared with pneumatic dilatation for treatment of oesophageal achalasia. 168 20

Pneumatic dilatation was performed for oesophageal achalasia in 19 consecutive patients without previous endoscopic or surgical treatment. There were no complications. Relief of symptoms was excellent or good in 11 cases during follow-up averaging 43 months. The outcome was better in patients older than 45 years than in younger patients. More than two repetitions of dilatation did not improve the results. Modified Heller's cardiomyotomy was performed on five patients with poor result after two to six dilatations. Pneumatic dilatation is safe and effective as initial treatment of oesophageal achalasia particularly in older patients, with cardiomyotomy reserved for those who do not respond to two dilatations.
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PMID:Pneumatic dilatation in oesophageal achalasia. Factors influencing results. 175 95


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