Purpose

Symptom recurrence after initial surgical management of esophageal achalasia occurs in 10–25% of patients. The aim of this study was to analyze safety and efficacy of revisional therapy after failed Heller myotomy (HM).

Methods

A retrospective review of a prospective database was performed searching for patients with recurrent symptoms after primary surgical therapy for achalasia. Patients with previously failed HM were considered for the final analysis. The Foregut questionnaire, and the Atkinson and Eckardt scales were used to assess severity of symptoms. Objective investigations routinely included upper gastrointestinal endoscopy and barium swallow study. Redo treatments consisted of endoscopic pneumatic dilation (PD), laparoscopic HM, hybrid Ivor Lewis esophagectomy, or stapled cardioplasty. A yearly clinical and endoscopic follow-up was scheduled in all patients.

Results

Over a 20-year period, 26 patients with a median age of 66 years (IQR 19.5) underwent revisional therapy after failed HM for achalasia at a tertiary-care university hospital. The median time after index procedure was 10 years (IQR 21). Revisional therapy consisted of endoscopic pneumatic dilation (n=13), laparoscopic HM and fundoplication (n=10), esophagectomy (n=2), and stapled cardioplasty and fundoplication (n=1). Nine (34.6%) of these patients required further endoscopic or surgical treatments. There was no mortality, and the overall complication rate was 7.7%. At a median follow-up of 42 months (range 10–149), a significant decrease of dysphagia, regurgitation, chest pain, respiratory symptoms, and median Eckardt score (p<0.05) was noted.

Conclusion

In specialized and multidisciplinary centers, revisional therapy for achalasia is feasible, safe, and effective.

中文翻译：

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贲门失弛缓症 Heller 肌切开术后复发症状的修正治疗

目的

食管贲门失弛缓症的初始手术治疗后症状复发发生在 10-25% 的患者中。本研究的目的是分析 Heller 肌切开术 (HM) 失败后修正治疗的安全性和有效性。

方法

对一个前瞻性数据库进行了回顾性审查，以寻找在贲门失弛缓症初级手术治疗后出现复发症状的患者。先前 HM 失败的患者被考虑用于最终分析。Foregut 问卷以及 Atkinson 和 Eckardt 量表用于评估症状的严重程度。客观调查常规包括上消化道内窥镜检查和钡剂吞咽研究。重做治疗包括内窥镜气动扩张术 (PD)、腹腔镜 HM、混合 Ivor Lewis 食管切除术或吻合器心脏成形术。每年对所有患者进行临床和内镜随访。

结果

在 20 年的时间里，26 名中位年龄为 66 岁（IQR 19.5）的患者在 HM 因贲门失弛缓症失败后在一家三级护理大学医院接受了修正治疗。指数手术后的中位时间为 10 年（IQR 21）。修正治疗包括内镜气动扩张术（n = 13）、腹腔镜 HM 和胃底折叠术（n = 10）、食管切除术（ n = 2）和吻合器心脏成形术和胃底折叠术（n = 1）。这些患者中有九名（34.6%）需要进一步的内窥镜或手术治疗。无死亡率，总并发症发生率为7.7%。在中位随访 42 个月（范围 10-149）时，吞咽困难、反流、胸痛、呼吸道症状和 Eckardt 评分中位数显着降低（p <0.05) 被注意到。

结论

在专业和多学科中心，贲门失弛缓症的修正治疗是可行、安全和有效的。