A Comprehensive Appraisal of the Surgical Treatment of Diffuse Esophageal Spasm
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Diffuse esophageal spasm is a motility disorder of undetermined cause. The optimal treatment remains controversial, and evidence-based data are lacking. Several medical treatment modalities have been proposed, but none has emerged as the treatment of choice. Patients who do not respond to medical therapy may be considered for surgical treatment. The surgical treatment of diffuse esophageal spasm is based on similar principles to the treatment of achalasia. A long esophageal myotomy is done to divide the hypertrophied circular muscle that is frequently noted in diffuse esophageal spasm. To protect against postoperative reflux, an antireflux procedure may be added. However, the surgical treatment of diffuse esophageal spasm has not been subjected to randomized clinical trials. The purpose of this article is to provide a review of the available literature regarding the surgical management of the diffuse esophageal spasm. In particular, we offer an appraisal of surgical outcomes, the effects of surgery on manometric and radiologic parameters (when available), complications, and mortality.
KeywordsEsophageal myotomy Esophageal spasm Esophageal spastic disorders Surgical treatment
Diffuse esophageal spasm
Hypertensive lower esophageal sphincter
Lower esophageal sphincter
Dr Almansa was the recipient of the 2006 Jon I. Isenberg, MD, International Research Scholar Award.
Editing, proofreading, and reference verification were provided by the Section of Scientific Publications, Mayo Clinic.
This paper was supported by a grant from the Foundation of the American Gastroenterological Association and Sociedad Española de Patología Digestiva.
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