Skip to main content

Advertisement

SpringerLink
Log in

Achalasia and Other Esophageal Motility Disorders

  • 2011 SSAT Annual Meeting
  • Review Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertensive lower esophageal sphincter are considered primary esophageal motility disorder. These disorders are characterized by esophageal dysmotility that is responsible for the symptoms. While there is today a reasonable consensus about the pathophysiology, the diagnosis, and the treatment of achalasia, this has not occurred for the other disorders. A careful evaluation is therefore necessary before an operation is considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Richter JE. Oesophageal motility disorders. Lancet 2001;358:823–28.

    Article  PubMed  CAS  Google Scholar 

  2. Fisichella PM, Raz D, Palazzo F, Niponmick I, Patti MG. Clinical, radiological, and manometric profile in 145 patients with untreated achalasia. World J Surg 2008;32:1974–1979.

    Article  PubMed  Google Scholar 

  3. Patti MG, Diener U, Molena D. Esophageal achalasia: preoperative assessment and postoperative follow-up. J Gastrointest Surg 2001;5:11–2.

    Article  PubMed  CAS  Google Scholar 

  4. Moonka R, Patti MG, Feo CV, Arcerito M, De Pinto M, Horgan S, Pellegrini CA. Clinical presentation and evaluation of malignant pseudoachalasia. J Gastrointest Surg 1999;3:456–61.

    Article  PubMed  CAS  Google Scholar 

  5. Pandolfino, JE, Kwiatek MA, Nealis T, Bulsiewicz W, Post J, Kahrilas PJ. Achalasia: a new clinically relevant classification by high-resolution manometry. Gastroenterology 2008;135:1526–1533.

    Article  PubMed  Google Scholar 

  6. Salvador R, Costantini M, Zaninotto G, Morbin T, Rizzetto C, Zanatta L, Ceolin M, Finotti E, Nicoletti L, Da Dalt G, Cavallin F, Ancona E. The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. J Gastrointest Surg 2010;14:1635–1645.

    Article  PubMed  Google Scholar 

  7. Pellegrini C, Wetter A, Patti MG, Leichter R, Mussan G, Mori T, Bernstein G, Way L. Thoracoscopic Esophagomyotomy—Initial experience with a new approach for the treatment of achalasia. Ann Surg 1992;216:291–299.

    Article  PubMed  CAS  Google Scholar 

  8. Patti, MG, Pellegrini CA, Horgan S, Arcerito, M, Omelanczuk P, Tamburini A, Diener U, Eubanks TR, Way LW. Minimally Invasive Surgery-an 8-year experience with 168 patients. Ann Surg 1999;230:587–94.

    Article  PubMed  CAS  Google Scholar 

  9. Perrone JM, Frisella MM, Desai KM, Soper NJ. Results of laparoscopic Heller-Toupet operation for achalasia. Surg Endosc 2004;18:1565–1571.

    PubMed  CAS  Google Scholar 

  10. Khajanchee YS, Kanneganti S, Leatherwood AEB, Hansen PD, Swanstrom LL. Laparoscopic Heller myotomy with Toupet fundoplication. Arch Surg 2005;140:827–834.

    Article  PubMed  Google Scholar 

  11. Zaninotto G, Costantini M, Rizzetto C, Zanatta L, Guirroli E, Portale G, Nicoletti L, Cavallin F, Battaglia G, Ruol A, Ancona E. Four hundred laparoscopic myotomies for esophageal achalasia – A single centre experience. Ann Surg 2008;248:986–993.

    Article  PubMed  Google Scholar 

  12. Rosemurgy AS, Morton CA, Rosas M, Albrink M, Ross SB. A single institution’s experience with more than 500 laparoscopic Heller myotomies for achalasia. J Am Coll Surg 2010;210:637–647.

    Article  PubMed  Google Scholar 

  13. Patti MG, Fisichella PM, Perretta S, Galvani C, Gorodner MV, Robinson T, Way LW. Impact of minimally invasive surgery on the treatment of esophageal achalasia: a decade of change. J Am Coll Surg 2003;196:698–705.

    Article  PubMed  Google Scholar 

  14. Wang YR, Dempsey DT, Friedenberg FK, Richter JE. Trends of Heller myotomy hospitalizations for achalasia in the United States, 1993–2005: effect of surgery volume on perioperative outcomes. Am J Gastroenterol 2008;103:1–11.

    Article  Google Scholar 

  15. Vaezi MF, Richter JE, Wilcox CM, Schroeder PL, Birgisson S, Slaughter RL, Koehler RE, Baker ME. Botulinum toxin versus pneumatic dilatation in the treatment of achalasia: a randomised trial. Gut 1999;44:231–239.

    Article  PubMed  CAS  Google Scholar 

  16. Zaninotto G, Annese V, Costantini M, Del Genio A, Costantino M, Epifani M, Gatto G, d’onofrio V, Benini L, Contini S, Molena D, Battaglia G, Tardio B, Andriulli A, Ancona E (2004) Randomized controlled trial of botulinum toxin versus laparoscopic Heller myotomy for esophageal achalasia. Ann Surg 239:364–370

    Article  PubMed  Google Scholar 

  17. Eckardt VF, Gockel I, Bernhard G. Pneumatic dilation for achalasia: late results of a prospective follow up investigation. Gut 2004;53:629–633.

    Article  PubMed  CAS  Google Scholar 

  18. Kostic S, Kjellin A, Ruth M, Lonroth H, Johnsson E, Andersson M, Lundell L. Pneumatic dilatation or laparoscopic cardiomyotomy in the management of newly diagnosed idiopathic achalasia. World J Surg 2007;31:470–478.

    Article  PubMed  CAS  Google Scholar 

  19. Patti MG, Fisichella PM. Laparoscopic Heller myotomy and Dor fundoplication for esophageal achalasia. How I do it. J Gastrointest Surg 2008;12:764–766.

    Article  PubMed  Google Scholar 

  20. Tatum RP, Pellegrini CA. How I do it: laparoscopic Heller myotomy with Toupet fundoplication for achalasia. J Gastrointest Surg 2009;13:1120–1124.

    Article  PubMed  Google Scholar 

  21. Oelschlager BK, Chang L, Pellegrini CA. Improved outcome after extended gastric myotomy for achalasia. Arch Surg 2003;138:490–497.

    Article  PubMed  Google Scholar 

  22. Patti MG, Feo CV, Arcerito M, De Pinto M, Tamburini A, Diener U, Gantert W, Way LW. Effects of previous treatment on results of laparoscopic Heller myotomy for achalasia. Digestive Disease and Sciences 1999;44:2270–2276.

    Article  CAS  Google Scholar 

  23. Portale G, Costantini M, Rizzetto C, Guirroli E, Ceolin M, Salvador R, Ancona E, Zaninotto G. Long-term outcome of laparoscopic Heller–Dor surgery for esophageal achalasia: possible detrimental role of previous endoscopic treatment. J Gastrointest Surg 2005;9:1332–1339.

    Article  PubMed  Google Scholar 

  24. Smith CD, Stival A, Howell DL, Swafford V. Endoscopic therapy for achalasia before Heller myotomy results in worse outcomes than Heller myotomy along. Ann Surg 2006;243:579–586.

    Article  PubMed  Google Scholar 

  25. Devaney EJ, Iannettoni MD, Orringer MB, Marshall B. Esophagectomy for achalasia: patient selection and clinical experience. Ann Thorac Surg 2001;72:854–8.

    Article  PubMed  CAS  Google Scholar 

  26. Richards WO, Torquati A, Holzman MD, Khaitan L, Byrne D, Lutfi R, Sharp KW. Heller myotomy versus Heller myotomy with Dor fundoplication for achalasia. Ann Surg 2004;240:405–415.

    Article  PubMed  Google Scholar 

  27. Patti MG, Robinson T, Galvani C, Gorodner MV, Fisichella PM, Way LW. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg 2004;198:863–870.

    Article  PubMed  Google Scholar 

  28. Zhu ZJ, Chen LQ, Duranceau A. Long-term result of total versus partial fundoplication after esophagomyotomy for primary esophageal motor disorders. World J Surg 2008;32:401–407.

    Article  PubMed  Google Scholar 

  29. Rebecchi F, Giaccone C, Farinella E, Campaci R, Morino M. Randomized controlled trial of laparoscopic Heller myotomy plus Dor fundoplication versus Nissen fundoplication for achalasia. Ann Surg 2008;248:1023–1030.

    Article  PubMed  Google Scholar 

  30. Patti MG, Herbella FA. Fundoplication after laparoscopic Heller myotomy for esophageal achalasia: What type? J Gastrointest Surg 2010;14:1453–1458.

    Article  PubMed  Google Scholar 

  31. Mineo TC, Pompeo E. Long-term outcome of Heller myotomy in achalasic sigmoid esophagus. J Thorac Cardiovasc Surg 2004;128:402–407.

    Article  PubMed  Google Scholar 

  32. Faccani E, Mattioli S, Lugaresi ML, Di Simone MP, Bartalena T, Pilotti V. Improving the surgery for sigmoid achalasia: long-term results of a technical detail. European Journal of Cardio-thoracic Surgery 2007;32:827–833.

    Article  PubMed  Google Scholar 

  33. Sweet MP, Nipomnick I, Gasper WJ, Bagatelos K, Ostroff JW, Fisichella PM, Way LW, Patti MG. The outcome of laparoscopic Heller myotomy for achalasia is not influenced by the degree of esophageal dilatation. J Gastrointest Surg 2008;12:159–65.

    Article  PubMed  Google Scholar 

  34. Patti MG, Molena D, Fisichella PM, Whang K, Yamada H, Perretta S, Way LW. Laparoscopic Heller myotomy and Dor fundoplication for achalasia. Arch Surg 2001;136:870–877.

    Article  PubMed  CAS  Google Scholar 

  35. Petersen RP, Pellegrini CA. Revisional surgery after Heller myotomy for esophageal achalasia. Surg Laparosc Endosc Percutan Tech 2010;20:321–325.

    Article  PubMed  Google Scholar 

  36. Robinson TN, Galvani CA, Dutta SK, Gorodner MV, Patti MG. Laparoscopic treatment of recurrent dysphagia following transthoracic myotomy for achalasia. J Laparoendoscopic & Advanced Surgical Techniques 2003;13:401–403.

    Article  Google Scholar 

  37. Grotenhuis BA, Wijnhoven PL, Myers JC, Jamieson GG, Devitt PG, Watson DI. Reoperation for dysphagia after cardiomyotomy for achalasia. Am J Surg 2007;194:678–682.

    Article  PubMed  Google Scholar 

  38. Guardino JM, Vela MF, Connor JT, Richter JE. Pneumatic dilation for the treatment of achalasia in untreated patients and patients with failed Heller myotomy. J Clin Gastroenterol 2004;38:855–860.

    Article  PubMed  Google Scholar 

  39. Herbella FA, Tineli AC, Wilson Jr. JL, Del Grande JC. Surgical treatment of primary esophageal motility disorders. J Gastrointest Surg 2008;12:604–608.

    Article  PubMed  Google Scholar 

  40. Patti MG, Gorodner MV, Galvani C, Tedesco P, Fisichella PM, Ostroff JW, Bagatelos KC, Way LW. Spectrum of esophageal motility disorders. Arch Surg 2005;140:442–449.

    Article  PubMed  Google Scholar 

  41. Herbella FAM, Raz DJ, Nipomnick I, Patti MG. Primary versus secondary esophageal motility disorders: diagnosis and implications for treatment. J Laparoendoscopic & Advanced Surgical Techniques 2009;19:195–198.

    Article  Google Scholar 

  42. Leconte M, Douard R, Gaudric M, Dumontier I, Chaussade S, Dousset B. Functional results after extended myotomy for diffuse oesophageal spasm. British J of Surgery 2007;94:1113–1118.

    Article  CAS  Google Scholar 

  43. Almansa C, Hinder RA, Smith CD, Achem SR. A comprehensive appraisal of the surgical treatment of diffuse esophageal spasm. J Gastrointest Surg 2008;12:1133–1145.

    Article  PubMed  Google Scholar 

  44. Nehra D, Lord RV, DeMeester TR, Theisen J, Peters JH, Crookes PF, Bremner CG. Physiologic basis for the treatment of epiphrenic diverticulum. Annals of Surgery 2002;235:346–354.

    Article  PubMed  Google Scholar 

  45. Tedesco P, Fisichella PM, Way LW, Patti MG. Cause and treatment of epiphrenic diverticula. Am J Surg 2005;190:902–905.

    Article  Google Scholar 

  46. Varghese TK, Marshall B, Chang AC, Pickens A, Lau CL, Orringer MB. Surgical treatment of epiphrenic diverticula: a 30-year experience. Ann Thorac Surg 2007;84:1801–9.

    Article  PubMed  Google Scholar 

  47. Melman L, Quinlan J, Robertson B, Brunt LM, Halpin VJ, Eagon JC, Frisella MM, Matthews BD. Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula. Surg Endosc 2009;23:1337–1341.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Ave, MC 5095, Room G-201, Chicago, IL, 60637, USA

    Marco G. Patti & Fernando A. Herbella

Authors
  1. Marco G. Patti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fernando A. Herbella
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marco G. Patti.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Patti, M.G., Herbella, F.A. Achalasia and Other Esophageal Motility Disorders. J Gastrointest Surg 15, 703–707 (2011). https://doi.org/10.1007/s11605-011-1478-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-011-1478-x

Keywords

Search

Navigation