Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders
M. G. Patti, C. A. Pellegrini, M. Arcerito, J. Tong, S. J. Mulvihill and L. W. Way
Department of Surgery, University of California, San Francisco, USA.
OBJECTIVE: To compare medical with minimally invasive surgical therapy in
the treatment of primary esophageal motility disorders. DESIGN: Prospective
study. SETTING: University-based tertiary care center. PATIENTS:
Eighty-nine patients (46 men and 43 women) with either achalasia or
nutcracker esophagus and diffuse esophageal spasm (DES). Choice of
treatment was based not on randomization but on the preference of the
referring physician, the patient's choice, and/or the patient's eligibility
to access the University of California, San Francisco, for treatment.
INTERVENTIONS: Nineteen patients with achalasia and 30 patients with
nutcracker esophagus and DES were treated with dilatations and/or
medications. Thirty patients with achalasia and 10 with nutcracker
esophagus and DES underwent a thoracoscopic myotomy. MAIN OUTCOME MEASURES:
Dysphagia, pain, and overall quality of life. RESULTS: In the surgical
group, 80% of the patients with nutcracker esophagus and DES and 87% of the
patients with achalasia had good or excellent results. In contrast, in the
medical group, 26% of the patients with nutcracker esophagus and DES and
26% of the patients with achalasia had good or excellent results.
CONCLUSIONS: Surgery by minimally invasive techniques offers a better
chance than does medical therapy or dilatation of rendering the patient
with achalasia, nutcracker esophagus, and DES asymptomatic.
