Universität zu Köln

Gutschow, Christian Alexander, Toex, Ulrich, Leers, Jessica, Schaefer, Hartmut, Prenzel, Klaus Ludwig and Hoelscher, Arnulf H. (2010). Botox, dilation, or myotomy? Clinical outcome of interventional and surgical therapies for achalasia. Langenbecks Arch. Surg., 395 (8). S. 1093 - 1100. NEW YORK: SPRINGER. ISSN 1435-2451

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Abstract

Purpose Achalasia is a rare, but well-defined primary esophageal motor disorder. Classic therapeutic approaches include botulinum toxin injection, balloon dilation, and surgical myotomy of the lower esophageal sphincter. This report summarizes our experience with different treatment modalities for achalasia. Methods Forty-three patients with achalasia treated in our hospital were subdivided according to therapeutic strategy: endoscopic botulinum toxin injection into the lower esophageal sphincter (EBTI; n=7), endoscopic esophageal balloon dilation (EBD; n=16), surgical myotomy after failed esophageal balloon dilation (EBD-HM; n=14), and first-line surgical myotomy (HM; n=6). Therapeutic efficiency was evaluated comparing standardized symptom scores preoperatively and at follow-up. Results There was no mortality and no significant difference between the groups for age, sex, or morbidity. The mean follow-up was at 9, 35, 38, and 17 months. At follow-up, recurrent or persistent symptoms were found in 71.4%, 6.3%, 35.7%, and 16.7% in EBTI, EBD, EBD-HM, and HM, respectively. Considering EBD-HM patients as failures of esophageal dilation, the total rate of recurrent or persistent symptoms after EBD was 50%. Poor symptomatic outcome was correlated to a low esophageal sphincter pressure during pretherapeutic manometry (p=0.03) and to sigmoid-shaped esophageal dilatation (p=0.06). Conclusion Surgical myotomy is the most reliable first-line therapy for achalasia, particularly in patients with a high sphincter pressure and moderate esophageal dilatation. Botox injection has a high failure rate and should be reserved for exceptional cases. Endoscopic dilation provides about 50% of patients with long-term symptomatic relief; in most cases, failure can be successfully treated surgically.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Gutschow, Christian Alexander UNSPECIFIED UNSPECIFIED UNSPECIFIED Toex, Ulrich UNSPECIFIED UNSPECIFIED UNSPECIFIED Leers, Jessica UNSPECIFIED UNSPECIFIED UNSPECIFIED Schaefer, Hartmut UNSPECIFIED UNSPECIFIED UNSPECIFIED Prenzel, Klaus Ludwig UNSPECIFIED UNSPECIFIED UNSPECIFIED Hoelscher, Arnulf H. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-493714
DOI:	10.1007/s00423-010-0711-5
Journal or Publication Title:	Langenbecks Arch. Surg.
Volume:	395
Number:	8
Page Range:	S. 1093 - 1100
Date:	2010
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1435-2451
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ESOPHAGEAL ACHALASIA; PNEUMATIC DILATION; HELLER MYOTOMY; LAPAROSCOPIC MYOTOMY; BOTULINUM TOXIN; FOLLOW-UP; ESOPHAGOMYOTOMY; DILATATION Multiple languages Surgery Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/49371