Journal of Gastrointestinal Surgery

, Volume 12, Issue 6, pp 1133–1145 | Cite as

A Comprehensive Appraisal of the Surgical Treatment of Diffuse Esophageal Spasm

  • Cristina Almansa
  • Ronald A. Hinder
  • C. Daniel Smith
  • Sami R. AchemEmail author
review article


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.


Esophageal myotomy Esophageal spasm Esophageal spastic disorders Surgical treatment 



Diffuse esophageal spasm


Gastroesophageal reflux


Hypertensive lower esophageal sphincter


Lower esophageal sphincter


Nutcracker esophagus



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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Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Cristina Almansa
    • 2
  • Ronald A. Hinder
    • 1
  • C. Daniel Smith
    • 1
  • Sami R. Achem
    • 2
    Email author
  1. 1.Section of General SurgeryMayo ClinicJacksonvilleUSA
  2. 2.Division of Gastroenterology and HepatologyMayo ClinicJacksonvilleUSA

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