Treatment Status and Progress of Achalasia_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGGang ¹ ,  ZHANGXun ²

1. Tianjin Medical University, Tianjin 300070, P. R. China;
2. Department of Thoracic Surgery, Tianjin Chest Hospital, Tianjin 300051, P. R. China;

Corresponding author：

ZHANGXun, Email: zhangxun69@163.com

Keywords：

Achalasia; Pneumatic dilatation; Laparoscopy; Modified Heller myotomy; Fundoplication

DOI：

10.7507/1007-4848.20140029

Video：

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Abstract Full text Figures/Tables Video References Cited by

Achalasia is a rare motor disorder of the esophagus and its etiology and pathogenesis remain unclear. Its clinical presentation typically includes various degrees of dysphagia, regurgitation, aspiration, chest pain and weight loss. The main therapy purpose for achalasia is to reduce lower esophageal sphincter pressure (LESP) so as to alleviate clinical symptoms. There are a variety of treatment methods for achalasia, such as pharmacotherapy, intrasphincteric botulinum toxin injection, endoscopic pneumatic dilatation and surgical intervention. At present, most scholars prefer laparoscopic or thorascopic surgery to achieve satisfactory long-term results including alleviated symptoms and prevention of acid reflux. However, great controversy still exists among scholars regarding the choice of conservative therapy or surgery, transthoracic or transabdominal surgery, optimal distal extent of myotomy, the need and choice of additional antireflux procedures. In this review, we focus on current therapy and progress of achalasia.

Citation： WANGGang, ZHANGXun. Treatment Status and Progress of Achalasia. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(1): 107-111. doi: 10.7507/1007-4848.20140029 Copy

1.	Farrokhi F,Vaezi MF.Idiopathic (primary) achalasia.Orphanet J Rare Dis,2007,26 (2):38.
2.	Hulselmans M,Vanuytsel T,Degreef T,et al.Long-term outcome of pneumatic dilation in the treatment of achalasia.Clin Gastroenterol Hepatol,2010,8 (1):30-35.
3.	Zerbib F,Thétiot V,Richy F,et al.Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia.Am J Gastroenterol,2006,101 (4):692-697.
4.	Richards WO,Torquati A,Holzman MD,et al.Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia:a prospective randomized double-blind clinical trial.Ann Surg,2004,240 (3):405-412.
5.	Lindenmann J,Maier A,Eherer A,et al.The incidence of gastroesophageal reflux after transthoracic esophagocardio-myotomy without fundoplication:a long term follow-up.Eur J Cardiothorac Surg,2005,27 (3):357-360.
6.	Steffens LJ,Oumer R,Roberts R.Wrapped in controversy:trends in fundoplication at myotomy for achalasia in Christchurch.New Zealand Med J,2013,126 (1369):34-43.
7.	Popoff AM,Myers JA,Zelhart M,et al.Long-term symptom relief and patient satisfaction after Heller myotomy and Toupet fundoplication for achalasia.Am J Surg,2012,203 (3):339-342.
8.	Wang L,Li YM,Li L.Meta-analysis of randomized and controlled treatment trials for achalasia.Dig Dis Sci,2009,54 (11):2303-2311.
9.	Lake JM,Wong RK.Review article:the management of achalasia a comparison of different treatment modalities.Aliment Pharmacol Ther,2006,24 (6):909-918.
10.	Allescher HD,Storr M,Seige M,et al.Treatment of achlasia:Botulinum toxin injection vs.pneumatic balloon dilation.A prospective study with long-term follow-Up.Endoscopy,2001,33 (12):1007-1017.
11.	Roberts KE,Duffy AJ,Bell RL.Controversies in the treatment of gastroesophageal reflux and achalasia.World J Gastroenterol,2006,12 (20):3155-3161.
12.	Peracchia A,Bonavina L.Achlasia:dilation,injection or surgery? Can J Gastroenterol,2000,14 (5):441-443.
13.	Yamashita H,Ashida K,Fukuchi T,et al.Predictive factors associated with the success of pneumatic dilatation in Japanese patients with primary achalasia:a study using high-resolution manometry Digestion,2013,87 (1):23-28.
14.	Csendes A,Braghetto I,Henríquez A,et al.Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia.Gut,1989,30 (3):299-304.
15.	Kostic S,Johnsson E,Kjellin A,et al.Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia:results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy.Surg Endosc,2007,21 (7):1184-1189.
16.	Heller E.Extramucose cardioplastie beim chronischen cardiospasmus mit dilatation des oesophagus.Mitt Grengeb Med Chir,1913,2:141-149.
17.	Zaninotto G,Costantini M,Rizzetto C,et al.Four hundred laparoscopic myotomies for esophageal achalasia:a single centre experience Ann Surg,2008,248 (6):986-993.
18.	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.
19.	Dughera L,Chiaverina M,Cacciotella L,et al,Management of achalasia.Clin Exp Gastroenterol,2011,25 (4):33-41.
20.	Pantanali CA,Herbella FA,Henry MA,et al.Laparoscopic heller myotomy and fundoplication in patients with chagas' disease achalasia and massively dilated esophagus.Am Surg,2013,79 (1):72-75.
21.	Rohof WO,Boeckxstaens GE.Treatment of the patient with achalasia.Curr Opin Gastroenterol,2012,28 (4):389-394.
22.	Gaissert HA,Lin N,Wain JC,et al.Transthoracic heller myotomy for esophageal achalasia:analysis of long-term results.Ann Thorac Surg,2006,81 (6):2044-2049.
23.	Bagheri R,Haghi SZ,Noorshafiee S.Surgical treatment of achalasia:transabdominal versus transthoracic cardiomyotomy.Ann Thorac Cardiovasc Surg,2011,17 (3):254-259.
24.	Bandhuphat C,Sirikarn Y,Thiraphat C.Heller's cardiomyotomy with augmented toupet's fundoplication immediate and long term outcome.J Med Assoc Thai,2010,93 (12):1385-1390.
25.	Finley RJ,Rattenberry J,Clifton JC,et al.Practical approaches to the surgical management of achalasia.Am Surg,2008,74 (2):97-102.
26.	Zhou JH,Wang RW,Jiang YG,et al.Management of achalasia with transabdominal esophagocardiomyotomy and partial posterior fundoplication.Dis Esophagus,2006,19 (5):389-393.
27.	Vaos G,Demetriou L,Velaoras C,et al.Evaluating long-term results of modified Heller limited esophagomyotomy in children with esophageal achalasia.J Pediatr Surg,2008,43 (7):1262-1269.
28.	Douard R,Gaudric M,Chaussade S,et al.Functional results after laparoscopic Heller myotomy for achalasia:A comparative study to open surgery.Surgery,2004,136 (1):16-24.
29.	Fernando AV,Madureira,Angelo BL,et al.Quality of life after Heller-Dor's cardiomiotomy.Rev Col Bras Cir,2009,36 (3):193-198.
30.	Yano F,Omura N,Tsuboi K,et al.Single-incision laparoscopic Heller myotomy and Dor fundoplication for achalasia:report of a case.Surg Today,2012,42 (3):299-302.
31.	Palazzo F,Puglia S,Ciaccio G.End-stage achalasia in a patient with neurofibromatosis treated with laparoscopic Heller myotomy.Surg Laparosc Endosc Percutan Tech,2011,21 (5):e266-e269.
32.	Jara FM,Toledo-Pereyra LH,Lewis JR,et al.Long-term results of esophagomyotomy for achalasia of esophagus.Arch Surg,1979,114 (8):935-936.
33.	Oelschlager BK,Chang L,Pellegrini CA.Improved outcome after extended gastric myotomy for achalasia.Arch Surg,2003,138 (5):490-495.
34.	Di Martino N,Monaco L,Izzo G,et al.The effect of esophageal myotomy and myectomy on the lower esophageal sphincter pressure profile:intraoperative computerized manometry study.Dis Esophagus, 2005,18 (3):160-165.
35.	Parshad R,Hazrah P,Saraya A,et al.Symptomatic outcome of laparoscopic cardiomyotomy without an antireflux procedure:experience in initial 40 cases.Surg Laparosc Endosc Percutan Tech,2008,18 (2):139-143.
36.	Costantini M,Zaninotto G,Guirroli E,et al.The laparoscopic Heller-Dor operation remains an effective treatment for esophageal achalasia at a minimum 6-year follow-up.Surg Endosc,2005,19 (3):345-351.
37.	Roesch-Dietlen F,Pérez-Morales AG,Ballinas-Bustamante J,et al.Heller myotomy and laparoscopic fundoplication in achalasia.A retrospective experience.Cir Cir,2012,80 (1):38-43.
38.	Robert M,Poncet G,Mion F,et al.Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia.Monocentric prospective study of 106 cases.Surg Endosc,2008,22 (4):866-874.
39.	El Hak NG,Hamdy E,Abdalla T,et al.Laparoscopic heller myotomy for achalasia:analysis of successes and failures.Hepatogastroenterology, 2012,59 (117):1450-1454.
40.	Di Martino N,Brillantino A,Monaco L,et al.Laparoscopic calibrated ttal vs partial fundoplication following Heller myotomy for oesophageal achalasia.World J Gastroenterol,2011,17 (29):3431-3440.
41.	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):284-290.
42.	Rebecchi F,Giaccone C,Farinella E,et al.Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia:long-term results.Ann Surg,2008,248 (6):1023-1030.
43.	Braghetto I,Korn O,Valladares H,et al.Laparoscopic anterior cardiomyotomy plus anterior Dor fundoplication without division of lateral and posterior periesophageal anatomic structures for treatment of achalasia of the esophagus.Surg Laparosc Endosc Percutan Tech,2007,17 (5):369-374.

1. Farrokhi F,Vaezi MF.Idiopathic (primary) achalasia.Orphanet J Rare Dis,2007,26 (2):38.
2. Hulselmans M,Vanuytsel T,Degreef T,et al.Long-term outcome of pneumatic dilation in the treatment of achalasia.Clin Gastroenterol Hepatol,2010,8 (1):30-35.
3. Zerbib F,Thétiot V,Richy F,et al.Repeated pneumatic dilations as long-term maintenance therapy for esophageal achalasia.Am J Gastroenterol,2006,101 (4):692-697.
4. Richards WO,Torquati A,Holzman MD,et al.Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia:a prospective randomized double-blind clinical trial.Ann Surg,2004,240 (3):405-412.
5. Lindenmann J,Maier A,Eherer A,et al.The incidence of gastroesophageal reflux after transthoracic esophagocardio-myotomy without fundoplication:a long term follow-up.Eur J Cardiothorac Surg,2005,27 (3):357-360.
6. Steffens LJ,Oumer R,Roberts R.Wrapped in controversy:trends in fundoplication at myotomy for achalasia in Christchurch.New Zealand Med J,2013,126 (1369):34-43.
7. Popoff AM,Myers JA,Zelhart M,et al.Long-term symptom relief and patient satisfaction after Heller myotomy and Toupet fundoplication for achalasia.Am J Surg,2012,203 (3):339-342.
8. Wang L,Li YM,Li L.Meta-analysis of randomized and controlled treatment trials for achalasia.Dig Dis Sci,2009,54 (11):2303-2311.
9. Lake JM,Wong RK.Review article:the management of achalasia a comparison of different treatment modalities.Aliment Pharmacol Ther,2006,24 (6):909-918.
10. Allescher HD,Storr M,Seige M,et al.Treatment of achlasia:Botulinum toxin injection vs.pneumatic balloon dilation.A prospective study with long-term follow-Up.Endoscopy,2001,33 (12):1007-1017.
11. Roberts KE,Duffy AJ,Bell RL.Controversies in the treatment of gastroesophageal reflux and achalasia.World J Gastroenterol,2006,12 (20):3155-3161.
12. Peracchia A,Bonavina L.Achlasia:dilation,injection or surgery? Can J Gastroenterol,2000,14 (5):441-443.
13. Yamashita H,Ashida K,Fukuchi T,et al.Predictive factors associated with the success of pneumatic dilatation in Japanese patients with primary achalasia:a study using high-resolution manometry Digestion,2013,87 (1):23-28.
14. Csendes A,Braghetto I,Henríquez A,et al.Late results of a prospective randomised study comparing forceful dilatation and oesophagomyotomy in patients with achalasia.Gut,1989,30 (3):299-304.
15. Kostic S,Johnsson E,Kjellin A,et al.Health economic evaluation of therapeutic strategies in patients with idiopathic achalasia:results of a randomized trial comparing pneumatic dilatation with laparoscopic cardiomyotomy.Surg Endosc,2007,21 (7):1184-1189.
16. Heller E.Extramucose cardioplastie beim chronischen cardiospasmus mit dilatation des oesophagus.Mitt Grengeb Med Chir,1913,2:141-149.
17. Zaninotto G,Costantini M,Rizzetto C,et al.Four hundred laparoscopic myotomies for esophageal achalasia:a single centre experience Ann Surg,2008,248 (6):986-993.
18. 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.
19. Dughera L,Chiaverina M,Cacciotella L,et al,Management of achalasia.Clin Exp Gastroenterol,2011,25 (4):33-41.
20. Pantanali CA,Herbella FA,Henry MA,et al.Laparoscopic heller myotomy and fundoplication in patients with chagas' disease achalasia and massively dilated esophagus.Am Surg,2013,79 (1):72-75.
21. Rohof WO,Boeckxstaens GE.Treatment of the patient with achalasia.Curr Opin Gastroenterol,2012,28 (4):389-394.
22. Gaissert HA,Lin N,Wain JC,et al.Transthoracic heller myotomy for esophageal achalasia:analysis of long-term results.Ann Thorac Surg,2006,81 (6):2044-2049.
23. Bagheri R,Haghi SZ,Noorshafiee S.Surgical treatment of achalasia:transabdominal versus transthoracic cardiomyotomy.Ann Thorac Cardiovasc Surg,2011,17 (3):254-259.
24. Bandhuphat C,Sirikarn Y,Thiraphat C.Heller's cardiomyotomy with augmented toupet's fundoplication immediate and long term outcome.J Med Assoc Thai,2010,93 (12):1385-1390.
25. Finley RJ,Rattenberry J,Clifton JC,et al.Practical approaches to the surgical management of achalasia.Am Surg,2008,74 (2):97-102.
26. Zhou JH,Wang RW,Jiang YG,et al.Management of achalasia with transabdominal esophagocardiomyotomy and partial posterior fundoplication.Dis Esophagus,2006,19 (5):389-393.
27. Vaos G,Demetriou L,Velaoras C,et al.Evaluating long-term results of modified Heller limited esophagomyotomy in children with esophageal achalasia.J Pediatr Surg,2008,43 (7):1262-1269.
28. Douard R,Gaudric M,Chaussade S,et al.Functional results after laparoscopic Heller myotomy for achalasia:A comparative study to open surgery.Surgery,2004,136 (1):16-24.
29. Fernando AV,Madureira,Angelo BL,et al.Quality of life after Heller-Dor's cardiomiotomy.Rev Col Bras Cir,2009,36 (3):193-198.
30. Yano F,Omura N,Tsuboi K,et al.Single-incision laparoscopic Heller myotomy and Dor fundoplication for achalasia:report of a case.Surg Today,2012,42 (3):299-302.
31. Palazzo F,Puglia S,Ciaccio G.End-stage achalasia in a patient with neurofibromatosis treated with laparoscopic Heller myotomy.Surg Laparosc Endosc Percutan Tech,2011,21 (5):e266-e269.
32. Jara FM,Toledo-Pereyra LH,Lewis JR,et al.Long-term results of esophagomyotomy for achalasia of esophagus.Arch Surg,1979,114 (8):935-936.
33. Oelschlager BK,Chang L,Pellegrini CA.Improved outcome after extended gastric myotomy for achalasia.Arch Surg,2003,138 (5):490-495.
34. Di Martino N,Monaco L,Izzo G,et al.The effect of esophageal myotomy and myectomy on the lower esophageal sphincter pressure profile:intraoperative computerized manometry study.Dis Esophagus, 2005,18 (3):160-165.
35. Parshad R,Hazrah P,Saraya A,et al.Symptomatic outcome of laparoscopic cardiomyotomy without an antireflux procedure:experience in initial 40 cases.Surg Laparosc Endosc Percutan Tech,2008,18 (2):139-143.
36. Costantini M,Zaninotto G,Guirroli E,et al.The laparoscopic Heller-Dor operation remains an effective treatment for esophageal achalasia at a minimum 6-year follow-up.Surg Endosc,2005,19 (3):345-351.
37. Roesch-Dietlen F,Pérez-Morales AG,Ballinas-Bustamante J,et al.Heller myotomy and laparoscopic fundoplication in achalasia.A retrospective experience.Cir Cir,2012,80 (1):38-43.
38. Robert M,Poncet G,Mion F,et al.Results of laparoscopic Heller myotomy without anti-reflux procedure in achalasia.Monocentric prospective study of 106 cases.Surg Endosc,2008,22 (4):866-874.
39. El Hak NG,Hamdy E,Abdalla T,et al.Laparoscopic heller myotomy for achalasia:analysis of successes and failures.Hepatogastroenterology, 2012,59 (117):1450-1454.
40. Di Martino N,Brillantino A,Monaco L,et al.Laparoscopic calibrated ttal vs partial fundoplication following Heller myotomy for oesophageal achalasia.World J Gastroenterol,2011,17 (29):3431-3440.
41. 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):284-290.
42. Rebecchi F,Giaccone C,Farinella E,et al.Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia:long-term results.Ann Surg,2008,248 (6):1023-1030.
43. Braghetto I,Korn O,Valladares H,et al.Laparoscopic anterior cardiomyotomy plus anterior Dor fundoplication without division of lateral and posterior periesophageal anatomic structures for treatment of achalasia of the esophagus.Surg Laparosc Endosc Percutan Tech,2007,17 (5):369-374.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Treatment Status and Progress of Achalasia

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