| The preoperative manometric pattern predicts the outcome of surgical treatment for esophageal achalasia. | |
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MedLine Citation:
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PMID: 20830530 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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BACKGROUND: A new manometric classification of esophageal achalasia has recently been proposed that also suggests a correlation with the final outcome of treatment. The aim of this study was to investigate this hypothesis in a large group of achalasia patients undergoing laparoscopic Heller-Dor myotomy. METHODS: We evaluated 246 consecutive achalasia patients who underwent surgery as their first treatment from 2001 to 2009. Patients with sigmoid-shaped esophagus were excluded. Symptoms were scored and barium swallow X-ray, endoscopy, and esophageal manometry were performed before and again at 6 months after surgery. Patients were divided into three groups: (I) no distal esophageal pressurization (contraction wave amplitude <30 mmHg); (II) rapidly propagating compartmentalized pressurization (panesophageal pressurization >30 mmHg); and (III) rapidly propagating pressurization attributable to spastic contractions. Treatment failure was defined as a postoperative symptom score greater than the 10th percentile of the preoperative score (i.e., >7). RESULTS: Type III achalasia coincided with a longer overall lower esophageal sphincter (LES) length, a lower symptom score, and a smaller esophageal diameter. Treatment failure rates differed significantly in the three groups: I = 14.6% (14/96), II = 4.7% (6/127), and III = 30.4% (7/23; p = 0.0007). At univariate analysis, the manometric pattern, a low LES resting pressure, and a high chest pain score were the only factors predicting treatment failure. At multivariate analysis, the manometric pattern and a LES resting pressure <30 mmHg predicted a negative outcome. CONCLUSION: This is the first study by a surgical group to assess the outcome of surgery in 3 manometric achalasia subtypes: patients with panesophageal pressurization have the best outcome after laparoscopic Heller-Dor myotomy. |
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Authors:
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Renato Salvador; Mario Costantini; Giovanni Zaninotto; Tiziana Morbin; Christian Rizzetto; Lisa Zanatta; Martina Ceolin; Elena Finotti; Loredana Nicoletti; Gianfranco Da Dalt; Francesco Cavallin; Ermanno Ancona |
Publication Detail:
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Type: Journal Article Date: 2010-09-10 |
Journal Detail:
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Title: Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract Volume: 14 ISSN: 1873-4626 ISO Abbreviation: J. Gastrointest. Surg. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-18 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9706084 Medline TA: J Gastrointest Surg Country: United States |
Other Details:
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Languages: eng Pagination: 1635-45 Citation Subset: IM |
Affiliation:
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Department of Surgical and Gastroenterological Sciences, Clinica Chirurgica I, School of Medicine, University of Padova, Padova, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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