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Laparoscopy or Endoscopic Therapy for Recurrent Symptoms from Achalasia

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Difficult Decisions in Thoracic Surgery

Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

Recurrence of symptoms after cardiomyotomy, performed either surgically or by endoscopy, is not an uncommon event and may have different causes. When this occurs, patients should undergo a complete work-up including high-resolution manometry, pH-monitoring, barium swallow, and upper endoscopy to elucidate, as much as possible, the causes of failure of the primary treatment. Multiple therapeutic options are now available when symptoms recur: pneumatic dilation, re-do laparoscopic myotomy, peroral endoscopic myotomy (POEM), or re-do POEM. The evidence to support any of these options is very weak at most, but good clinical practice suggests starting from the less invasive therapy (pneumatic dilation) and scaling-up to the most invasive. POEM is a very attractive option to treat recurrences, however this statement is based only on a handful of isolated reports.

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Author information

Authors and Affiliations

  1. Department of Surgery and Cancer, Imperial College, London, UK

    Giovanni Zaninotto & Sheraz R. Markar

  2. University of Padova, Padova, Italy

    Giovanni Zaninotto

  3. College of Medicine, University of the Witwatersrand, Johannesburg, South Africa

    Nadia Guidozzi

  4. Department Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Sheraz R. Markar

Authors
  1. Giovanni Zaninotto
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  2. Nadia Guidozzi
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  3. Sheraz R. Markar
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Corresponding author

Correspondence to Giovanni Zaninotto .

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Editors and Affiliations

  1. Department of Surgery, University of Chicago, Chicago, IL, USA

    Mark K. Ferguson

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Zaninotto, G., Guidozzi, N., Markar, S.R. (2020). Laparoscopy or Endoscopic Therapy for Recurrent Symptoms from Achalasia. In: Ferguson, M. (eds) Difficult Decisions in Thoracic Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-47404-1_40

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  • DOI: https://doi.org/10.1007/978-3-030-47404-1_40

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-47403-4

  • Online ISBN: 978-3-030-47404-1

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