LATE EVALUATION OF DYSPHAGIA AFTER HELLER ESOPHAGEAL MYOTOMY WITH DOR FUNDOPLICATION FOR ACHALASIA.

Eduardo Rodrigues Zarco Câmara,Delta Madureira,Antonio Carlos Ribeiro Garrido Iglesias,Fernando Athayde Veloso Madureira,Renato Manganelli Salomão

doi:10.1590/0102-6720201700030005

Abstract

ABSTRACT Background: All available treatments for achalasia are palliative and aimed to eliminate the flow resistance caused by a hypertensive lower esophageal sphincter. Aim:To analyze the positive and negative prognostic factors in the improvement of dysphagia and to evaluate quality of life in patients undergoing surgery to treat esophageal achalasia by comparing findings before, immediately after, and in long follow-up. Methods:A total of 84 patients who underwent surgery for achalasia between 2001 and 2014 were retrospectively studied. The evaluation protocol with dysphagia scores compared preoperative, immediate (up to three months) postoperative and late (over one year) postoperative scores to estimate quality of life. Results:The surgical procedure was Heller-Dor in 100% of cases, with 84 cases performed laparoscopically. The percent reduction in pre- and immediate postoperative lower esophageal sphincter pressurewas 60.35% in the success group and 32.49% in the failure group. Regarding the late postoperative period, the mean percent decrease was 60.15% in the success group and 31.4% in the failure group. The mean overall drop in dysphagia score between the pre- and immediate postoperative periods was 7.33 points, which represents a decrease of 81.17%. Conclusions:Reduction greater than 60% percent in lower esophageal sphincter pressurebetween the pre- and postoperative periods suggests that this metric is a predictor of good prognosis for surgical response. Surgical treatment was able to have a good affect in quality of life and drastically changed dysphagia over time.

Highlights

Esophageal achalasia is an uncommon motility disorder of the esophagus, with an incidence of between 0.03 to 1 per 100,000 individuals[5] with no preference in terms of age or gender[14]
LESP=lower esophageal sphincter pressure postoperative periods was 7.33 points, which represents a decrease of 81.17% (Figure 3, p=0.0001)
There was no significant difference between pre- and immediate postoperative periods and late postoperative fall

Summary

Introduction

Esophageal achalasia is an uncommon motility disorder of the esophagus, with an incidence of between 0.03 to 1 per 100,000 individuals[5] with no preference in terms of age or gender[14]. Infection by Trypanosoma cruzi has had a major impact in South American countries, in Brazil, and is known that approximately 5% of patients affected by Chagas disease develop achalasia[19] This disease is insidious, and the main symptom is dysphagia. All available treatments for achalasia are palliative and are aimed at eliminating the flow resistance caused by a hypertensive lower esophageal sphincter. These treatments attempt to improve symptoms related to esophageal stasis, such as dysphagia and regurgitation[28].

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