Abstract
A 74-year-old man, who had previously received curative distal gastrectomy for gastric cancer, was admitted to our hospital with severe dysphagia and weight loss. Barium swallow examination revealed the esophagus to have the corkscrew appearance characteristic of diffuse esophageal spasm (DES). This diagnosis was confirmed by esophageal manometry, which revealed intermittent, simultaneous, high-amplitude (30–100 mmHg) contractions after 65% of wet swallows. The muscle layer was also found to be thickened throughout the spastic region. Long esophagomyotomy with fundoplication was performed after treatment with medication proved ineffective. Myotomy proceeded superiorly to the area under aortic arch and inferiorly 3 cm into the cardiac portion. Fluoroscopy of the esophagus after the operation showed the spastic changes to be absent, and the patient showed improved clinical signs. We therefore recommend long myotomy of the esophageal wall with antireflux surgery for DES with sever dysphagia that is resistant to conservative treatment.
Similar content being viewed by others
References
Richter JE. Oesophageal motility disorders. Lancet 2001; 358: 823–8.
Kahrilas PJ, Clouse RE, Hogan WJ. American Gastroenterological Association technical review on the clinical use of esophageal manometry. Gastroenterology 1994; 107: 1865–84.
Skinner DB, Belsey R. Management of esophageal disease. Philadelphia: Saunders, 1988: 431–40.
Clouse RE, Hallett JA. What degree of impaired peristalsis is important for the diagnosis of diffuse esophageal spasm. Am J Gastroeterol 1992; 87: 1246A.
Spechler SJ, Castell DO. Classification of oesophageal motility abnormalities. Gut 2001; 49: 145–51.
Pehlivanov N, Liu J, Kassab GS, Beaumont C, Mittal RK. Relationship between esophageal muscle thickness and intraluminal pressure in patients with esophageal spasm. Am J Physiol Gastrointest Liver Physiol 2002; 282: G1016–23.
Feussner H, Kauer W, Siewert JR. The surgical management of motility disorders. Dysphagia 1993; 8: 135–45.
Nastos D, Chen LQ, Ferrano P, Taillefer R, Duranceau AC. Long myotomy with antireflux repair for esophageal spastic disorders. J Gastrointest Surg 2002; 6: 713–22.
Pellegrini CA. Impact and evolution of minimally invasive techniques in the treatment of achalasia. Surg Endosc l997; 11: 1–2.
Robson K, Rosenberg S, Lembo T. GERD progressing to diffuse esophageal spasm and then to achalasia. Dig Dis Sci 2000; 45: 110–3.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Maruyama, K., Motoyama, S., Okuyama, M. et al. Successful surgical treatment for diffuse esophageal spasm. Jpn J Thorac Caridovasc Surg 53, 169–172 (2005). https://doi.org/10.1007/s11748-005-0027-5
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s11748-005-0027-5