A Comprehensive Appraisal of the Surgical Treatment of Diffuse Esophageal Spasm

Diffuse esophageal spasm is a motility disorder of undetermined cause. The optimal treatment remains controversial, and evidence-based data are lacking. Several medical treatment modalities have been proposed, but none has emerged as the treatment of choice. Patients who do not respond to medical th...

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Bibliographic Details
Published in:Journal of gastrointestinal surgery 2008-06, Vol.12 (6), p.1133-1145
Main Authors: Almansa, Cristina, Hinder, Ronald A., Smith, C. Daniel, Achem, Sami R.
Format: Article
Language:English
Subjects:
Digestive System Surgical Procedures - methods
Esophageal Spasm, Diffuse - diagnosis
Esophageal Spasm, Diffuse - surgery
Esophagus - surgery
Gastroenterology
Humans
Medical diagnosis
Medical disorders
Medicine
Medicine & Public Health
Muscle, Smooth - surgery
Review Article
Severity of Illness Index
Surgery
Treatment Outcome
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Summary:Diffuse esophageal spasm is a motility disorder of undetermined cause. The optimal treatment remains controversial, and evidence-based data are lacking. Several medical treatment modalities have been proposed, but none has emerged as the treatment of choice. Patients who do not respond to medical therapy may be considered for surgical treatment. The surgical treatment of diffuse esophageal spasm is based on similar principles to the treatment of achalasia. A long esophageal myotomy is done to divide the hypertrophied circular muscle that is frequently noted in diffuse esophageal spasm. To protect against postoperative reflux, an antireflux procedure may be added. However, the surgical treatment of diffuse esophageal spasm has not been subjected to randomized clinical trials. The purpose of this article is to provide a review of the available literature regarding the surgical management of the diffuse esophageal spasm. In particular, we offer an appraisal of surgical outcomes, the effects of surgery on manometric and radiologic parameters (when available), complications, and mortality.
ISSN:1091-255X
1873-4626
DOI:10.1007/s11605-007-0439-x