320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA

Abstract Background Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we...

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Published in:Diseases of the esophagus 2023-08, Vol.36 (Supplement_2)
Main Authors: Nezi, Giulia, Forattini, Francesca, Provenzano, Luca, Capovilla, Giovanni, Vittori, Arianna, Nicoletti, Loredana, Moletta, Lucia, Pierobon, Elisa Sefora, Costantini, Andrea, Valmasoni, Michele, Costantini, Mario, Salvador, Renato
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container_title Diseases of the esophagus
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creator Nezi, Giulia
Forattini, Francesca
Provenzano, Luca
Capovilla, Giovanni
Vittori, Arianna
Nicoletti, Loredana
Moletta, Lucia
Pierobon, Elisa Sefora
Costantini, Andrea
Valmasoni, Michele
Costantini, Mario
Salvador, Renato
description Abstract Background Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we aimed to compare the final outcome of the pull-down technique (PDLHD) with the results of classical myotomy (CLHD) in patients with end-stage achalasia. Methods From 1995–2022, patients with a radiological diagnosis of end-stage achalasia undergoing laparoscopic myotomy were enrolled in the study. Symptoms were quantified using the Eckardt score. Barium-swallow, endoscopy and manometry were performed before and after the treatment. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score > 3, or the need for retreatment. Results Of the 94 patients with end-stage achalasia (M:F = 52:42), 60 patients were treated with CLHD, and 34 patients with PDLHD. The surgical procedures were completed laparoscopically in all patients. During follow-up, two patients (2.1%) developed squamous cell carcinoma (SCC), both in the CLHD group. All patients in both groups had an improvement in their Eckardt score after surgery, and the failure rates were 27.6% (16/58) after CLHD and 5.9% (2/34) after PDLHD (p 
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ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA</title><source>Oxford Journals Online</source><creator>Nezi, Giulia ; Forattini, Francesca ; Provenzano, Luca ; Capovilla, Giovanni ; Vittori, Arianna ; Nicoletti, Loredana ; Moletta, Lucia ; Pierobon, Elisa Sefora ; Costantini, Andrea ; Valmasoni, Michele ; Costantini, Mario ; Salvador, Renato</creator><creatorcontrib>Nezi, Giulia ; Forattini, Francesca ; Provenzano, Luca ; Capovilla, Giovanni ; Vittori, Arianna ; Nicoletti, Loredana ; Moletta, Lucia ; Pierobon, Elisa Sefora ; Costantini, Andrea ; Valmasoni, Michele ; Costantini, Mario ; Salvador, Renato</creatorcontrib><description>Abstract Background Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we aimed to compare the final outcome of the pull-down technique (PDLHD) with the results of classical myotomy (CLHD) in patients with end-stage achalasia. Methods From 1995–2022, patients with a radiological diagnosis of end-stage achalasia undergoing laparoscopic myotomy were enrolled in the study. Symptoms were quantified using the Eckardt score. Barium-swallow, endoscopy and manometry were performed before and after the treatment. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score &gt; 3, or the need for retreatment. Results Of the 94 patients with end-stage achalasia (M:F = 52:42), 60 patients were treated with CLHD, and 34 patients with PDLHD. The surgical procedures were completed laparoscopically in all patients. During follow-up, two patients (2.1%) developed squamous cell carcinoma (SCC), both in the CLHD group. All patients in both groups had an improvement in their Eckardt score after surgery, and the failure rates were 27.6% (16/58) after CLHD and 5.9% (2/34) after PDLHD (p &lt; 0.01). Amongst the patients who underwent complete post-operative follow-up, an abnormal acid exposure was detected in 2 patients after PDLH, and in 6 after CLHD (p = n.s.). Conclusions Taken into account the intrinsic limitations of the study (different time window, and different follow-up), the results of this study indicate that performing the pull-down technique during Laparoscopic Heller-Dor improves the final outcome in end-stage achalasia patients.</description><identifier>ISSN: 1120-8694</identifier><identifier>EISSN: 1442-2050</identifier><identifier>DOI: 10.1093/dote/doad052.140</identifier><language>eng</language><publisher>Oxford University Press</publisher><ispartof>Diseases of the esophagus, 2023-08, Vol.36 (Supplement_2)</ispartof><rights>The Author(s) 2023. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2023</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Nezi, Giulia</creatorcontrib><creatorcontrib>Forattini, Francesca</creatorcontrib><creatorcontrib>Provenzano, Luca</creatorcontrib><creatorcontrib>Capovilla, Giovanni</creatorcontrib><creatorcontrib>Vittori, Arianna</creatorcontrib><creatorcontrib>Nicoletti, Loredana</creatorcontrib><creatorcontrib>Moletta, Lucia</creatorcontrib><creatorcontrib>Pierobon, Elisa Sefora</creatorcontrib><creatorcontrib>Costantini, Andrea</creatorcontrib><creatorcontrib>Valmasoni, Michele</creatorcontrib><creatorcontrib>Costantini, Mario</creatorcontrib><creatorcontrib>Salvador, Renato</creatorcontrib><title>320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA</title><title>Diseases of the esophagus</title><description>Abstract Background Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we aimed to compare the final outcome of the pull-down technique (PDLHD) with the results of classical myotomy (CLHD) in patients with end-stage achalasia. Methods From 1995–2022, patients with a radiological diagnosis of end-stage achalasia undergoing laparoscopic myotomy were enrolled in the study. Symptoms were quantified using the Eckardt score. Barium-swallow, endoscopy and manometry were performed before and after the treatment. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score &gt; 3, or the need for retreatment. Results Of the 94 patients with end-stage achalasia (M:F = 52:42), 60 patients were treated with CLHD, and 34 patients with PDLHD. The surgical procedures were completed laparoscopically in all patients. During follow-up, two patients (2.1%) developed squamous cell carcinoma (SCC), both in the CLHD group. All patients in both groups had an improvement in their Eckardt score after surgery, and the failure rates were 27.6% (16/58) after CLHD and 5.9% (2/34) after PDLHD (p &lt; 0.01). Amongst the patients who underwent complete post-operative follow-up, an abnormal acid exposure was detected in 2 patients after PDLH, and in 6 after CLHD (p = n.s.). Conclusions Taken into account the intrinsic limitations of the study (different time window, and different follow-up), the results of this study indicate that performing the pull-down technique during Laparoscopic Heller-Dor improves the final outcome in end-stage achalasia patients.</description><issn>1120-8694</issn><issn>1442-2050</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqFkDtPwzAUhS0EEqWwM3pHKdePJM1oGaeJ5MYhDxijxHElEKglgYF_j6t2Z7iP4ZwjnQ-hewIrAgl7HPffzq9-hJCuCIcLtCCc04BCCJf-JxSCdZTwa3Qzz-8AJGbReoG-GIUVVrUpM7FRQuOy1Tp4Mq8FbpTMivy5VTjflpV5UTVuMoXTvPAy0zbSbBU2KdaiFJWppSlziTOltap8QIVTP6p4CurGJ2MhM6FFnYtbdLXrP2Z3d75L1KaqkVmgzSaXQgeWkASCqA8ZZc4mnI7rXRQ7ljhwPGSj5SyJgFtfgEHPiNcP1o58iKGPBzIkNozjgS0RnHLttJ_nye26w_T22U-_HYHuiKw7IuvOyDqPzFseTpb9z-F_9R8dY2UZ</recordid><startdate>20230830</startdate><enddate>20230830</enddate><creator>Nezi, Giulia</creator><creator>Forattini, Francesca</creator><creator>Provenzano, Luca</creator><creator>Capovilla, Giovanni</creator><creator>Vittori, Arianna</creator><creator>Nicoletti, Loredana</creator><creator>Moletta, Lucia</creator><creator>Pierobon, Elisa Sefora</creator><creator>Costantini, Andrea</creator><creator>Valmasoni, Michele</creator><creator>Costantini, Mario</creator><creator>Salvador, Renato</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20230830</creationdate><title>320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA</title><author>Nezi, Giulia ; Forattini, Francesca ; Provenzano, Luca ; Capovilla, Giovanni ; Vittori, Arianna ; Nicoletti, Loredana ; Moletta, Lucia ; Pierobon, Elisa Sefora ; Costantini, Andrea ; Valmasoni, Michele ; Costantini, Mario ; Salvador, Renato</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1190-6a5323ec942d8f67e39e0e453dc439604c73630a31c11bccd4b70a7b1b9c577b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nezi, Giulia</creatorcontrib><creatorcontrib>Forattini, Francesca</creatorcontrib><creatorcontrib>Provenzano, Luca</creatorcontrib><creatorcontrib>Capovilla, Giovanni</creatorcontrib><creatorcontrib>Vittori, Arianna</creatorcontrib><creatorcontrib>Nicoletti, Loredana</creatorcontrib><creatorcontrib>Moletta, Lucia</creatorcontrib><creatorcontrib>Pierobon, Elisa Sefora</creatorcontrib><creatorcontrib>Costantini, Andrea</creatorcontrib><creatorcontrib>Valmasoni, Michele</creatorcontrib><creatorcontrib>Costantini, Mario</creatorcontrib><creatorcontrib>Salvador, Renato</creatorcontrib><collection>CrossRef</collection><jtitle>Diseases of the esophagus</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nezi, Giulia</au><au>Forattini, Francesca</au><au>Provenzano, Luca</au><au>Capovilla, Giovanni</au><au>Vittori, Arianna</au><au>Nicoletti, Loredana</au><au>Moletta, Lucia</au><au>Pierobon, Elisa Sefora</au><au>Costantini, Andrea</au><au>Valmasoni, Michele</au><au>Costantini, Mario</au><au>Salvador, Renato</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA</atitle><jtitle>Diseases of the esophagus</jtitle><date>2023-08-30</date><risdate>2023</risdate><volume>36</volume><issue>Supplement_2</issue><issn>1120-8694</issn><eissn>1442-2050</eissn><abstract>Abstract Background Patients with sigmoid shape have an advanced form of the disease and are considered the most difficult to treat. A modified technique (pull-down) has been proposed to straighten the esophageal axis, but there is a limited amount of data available in literature. In this study, we aimed to compare the final outcome of the pull-down technique (PDLHD) with the results of classical myotomy (CLHD) in patients with end-stage achalasia. Methods From 1995–2022, patients with a radiological diagnosis of end-stage achalasia undergoing laparoscopic myotomy were enrolled in the study. Symptoms were quantified using the Eckardt score. Barium-swallow, endoscopy and manometry were performed before and after the treatment. Treatment failure was defined as the persistence or reoccurrence of an Eckardt score &gt; 3, or the need for retreatment. Results Of the 94 patients with end-stage achalasia (M:F = 52:42), 60 patients were treated with CLHD, and 34 patients with PDLHD. The surgical procedures were completed laparoscopically in all patients. During follow-up, two patients (2.1%) developed squamous cell carcinoma (SCC), both in the CLHD group. All patients in both groups had an improvement in their Eckardt score after surgery, and the failure rates were 27.6% (16/58) after CLHD and 5.9% (2/34) after PDLHD (p &lt; 0.01). Amongst the patients who underwent complete post-operative follow-up, an abnormal acid exposure was detected in 2 patients after PDLH, and in 6 after CLHD (p = n.s.). Conclusions Taken into account the intrinsic limitations of the study (different time window, and different follow-up), the results of this study indicate that performing the pull-down technique during Laparoscopic Heller-Dor improves the final outcome in end-stage achalasia patients.</abstract><pub>Oxford University Press</pub><doi>10.1093/dote/doad052.140</doi><oa>free_for_read</oa></addata></record>
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title 320. ESOPHAGEAL PULL-DOWN TECHNIQUE IMPROVES THE FINAL OUTCOME OF LAPAROSCOPIC HELLER-DOR FOR END-STAGE ACHALASIA
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