42: THE LAPAROSCOPIC HELLER-DOR IS AN EFFECTIVE LONG-TERM TREATMENT FOR END-STAGE ACHALASIA. (23rd April 2022)

• Record Type: Journal Article
• Authors: Nezi, G; Forattini, F; Riccio, F; Vittori, A; Provenzano, L; Capovilla, G; Nicoletti, L; Moletta, L; Pierobon, E S; Zanchettin, G; Valmasoni, M; Merigliano, S; Costantini, M; Salvador, R
• Is Part Of: Diseases of the esophagus. Volume 35(2022)Supplement 1
• Publication Date: 2022-04-23
• Subjects: Esophagus -- Diseases -- Periodicals; 616.32
• DOI: 10.1093/dote/doac015.042
• Languages: English
• ISSNs: 1120-8694

Abstract

Abstract: Background and aim: Laparoscopic Heller-Dor (LHD) is an effective treatment for esophageal achalasia, with good long-term results in more than 85–90% of patients. It remains controversial whether LHD is also indicated in the end-stage disease when the esophagus has a sigmoid shape. The aim of this study was to evaluate the outcome of LHD in patients with end-stage achalasia, as compared to patients with megaesophagus but without a sigmoid shape. Methods: From 1992 to 2020, patients with a radiological diagnosis of sigmoid-shaped esophagus (radiological stage IV achalasia: group SE) and patients with straight, larger than 6 cm in diameter esophagus (radiological stage III achalasia: group NSE), both treated with LHD, were compared. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3, or the need for retreatment. Results: During the study period, 164 such patients were observed: 73 patients in the SE group and 91 in the NSE group. The patients' demographic and clinical parameters are summarised in Table 1. The median follow-up was 67 months (IQR: 24–106). No intra or postoperative mortality was recorded. There were 7 mucosal lesions: 2 in the SE group and 5 in the NSE group ( P = 0.45). A positive outcome was obtained in 73% of patients in the SE group, as compared to 90% in the NSE group ( P = 0.007, Table 2). All the patients whose surgery failed subsequently underwent one or more endoscopic pneumatic dilations. The overall success rate of the combination of LHD and endoscopic dilations was 83.6% in the SE group and all patients in the NSE group. The persisting failures had additional treatments: 4 patients a redo-myotomy, one each a botox injection, POEM and only one patient had an esophagectomy; the remaining 5 patients refused additional treatments. Postoperative 24-hour pH-monitoring was abnormal in 16.6% in SE group and 8.3% in NSE group ( P = 0.33). Conclusion: In end-stage achalasia patients, LHD may still achieve good results by relieving symptoms in more than 70% of patients. Therefore, LHD may still be the first surgical option to be offered to these patients before esophagectomy.