Achalasia of the esophagus |
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Authors: | Dr. Constantine Arvanitakis MD |
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Affiliation: | (1) Department of Medicine, University of Wisconsin School of Medicine, Madison, Wisconsin;(2) Department of Medicine, Kansas University School of Medicine, 66103 Kansas City, Kansas |
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Abstract: | 56 patients with achalasia of the esophagus were reviewed in a retrospective study to compare the results of a forceful pneumatic dilation with those of a Heller esophagomyotomy. 22 of 33 patients treated with forceful dilation (67%), showed relief of dysphagia and reduction in the average esophageal diameter by barium swallow during the follow-up period (mean=6.5 years). In 2 patients (6%), forceful dilation was complicated by esophageal perforation, promptly diagnosed, and successfully treated at surgery in both patients. 21 out of 23 patients who underwent esophagomyotomy (91%) showed permanent relief of symptoms and improvement by endoscopic and radiographic criteria. There were no significant postoperative complications during the follow-up period ranging between 1.5 and 10.0 years. The results of this study indicate that esophagomyotomy constitutes a more effective therapeutic modality than forceful dilation (P<0.05). Although esophageal dilation has a place in the treatment of early achalasia, esophagomyotomy appears to be a safer and a more successful form of treatment, of particular value in advanced esophageal disease and in those instances where pneumatic dilation fails to result in immediate clinical improvement. |
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