PS01.023: EXTENDING MYOTOMY BOTH DOWNWARDS AND UPWARDS FOR MANOMETRIC PATTERN III ACHALASIA PATIENTS IMPROVES THE FINAL OUTCOME. (14th September 2018)

• Record Type: Journal Article
• Authors: Salvador, Renato; Capovilla, Giovanni; Provenzano, Luca; Briscolini, Dario; Perazzolo, Anna; Nicoletti, Loredana; Valmasoni, Michele; Merigliano, Stefano; Costantini, Mario
• Is Part Of: Diseases of the esophagus. Volume 31(2018)Supplement 1
• Page Start: 56
• Page End: 57
• Publication Date: 2018-09-14
• Subjects: achalasia -- pattern III -- laparoscopic myotomy -- Heller-Dor; Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doy089.PS01.023
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background: Achalasia is at present classified in 3 manometric patterns. Pattern III is the most unfrequent pattern and is correlated with the worst outcome after all available treatments. We aimed to investigate the final outcome after classic laparoscopic myotomy (length ≤ 8cm, CLM) as compared with a longer laparoscopic myotomy both downwards and upwards with (length > 8cm, LLM) in patients with pattern III achalasia. Methods: The study population consisted of 50 consecutive patients with pattern III achalasia who underwent laparoscopic myotomy between 1997–2017. Patients who had already been treated with surgical or endoscopic procedures were ruled out. Patients before 2010 had a traditional CLM procedure while patients after 2010 had a LLM. Symptoms were collected and scored using a detailed questionnaire; barium-swallow, endoscopy, manometry (conventional or HRM) were performed, before and after surgical treatment. Results: Of the 50 patients representing the study population, 23 had CLM and 27 had LLM. In addition, all the patients add an anterior, partial fundoplication (Dor). The patients' demographic and clinical parameters (sex, symptom-score, duration of symptoms, esophageal-diameter) were similar in both groups. No intraoperative mucosal lesions were detected. The median length of the myotomy was 7 cm (IQR:7–8) in the CLM and 10 cm (IQR:10–11) in the LLM ( P < 0.001). The median of follow-up was 61 months (IQR:35–93) in the CLM and 24 months (IQR:16–36) in the LLM. As a whole, the two groups had a different drop in their symptom score: 21 (17–26) versus 6 (0–8), and 21 (18–27) versus 3 (0–6) for the CLM and LLM respectively ( P < 0.05). Moreover, failures were 7/23 (30%) in the CLM and 3/27 (11.1%) in the LLM ( P < 0.001). An abnormal acid exposure was detected after the treatment in 4 patients of CLM and in 3 of LLM ( P = n.s.). Conclusion: In spite of intrinsic limitations of the study (retrospective, different time window of the two procedures and different follow-up), the extension of the length of the myotomy both downwards and upwards improves the final outcome of the laparoscopic Heller-Dor procedure in patients with pattern III achalasia. On the other hand, a longer myotomy does not influence the development of postoperative gastroesophageal reflux. Disclosure: All authors have declared no conflicts of interest.