Category Archives: Heller myotomy

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? DISCUSSION (Part 3)

We assessed the predominant treatmentparadigm for achalasia, from the referring physicians’ perspective, with a six-question survey sent to all gastroenterologists in Quebec. Although the vast majority of respondents agreed that surgical myotomy represented the most effective and longest lasting treatmentfor achalasia, only slightly more than one-third referred newly diagnosed patients for immediate surgery. Rather, patients are offered endoscopic therapies (predominantly pneumatic dilation). Continue reading

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? DISCUSSION (Part 2)

Although we found no change in the absolute number of myotomies or in the rate of previous endoscopic therapy, Heller myotomy was performed on an older population and at a shorter time interval from the last endoscopic treatmentin the postlaparoscopy group. These changes suggest that the threshold for referral to myotomy may have diminished concurrently with the introduction of minimally invasive myotomy. Continue reading

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? DISCUSSION (Part 1)

Botulinum toxin We sought to determine the impact of the introduction of minimally invasive Heller myotomy for achalasia on the treatment patterns for this disease. An assessment of the local referral patterns has demonstrated that our own institution’s increasing experience in minimally invasive myotomy coincided with a reduction in the percentage of patients with previous endoscopic therapy. Although not reaching statistical significance, we found that the proportion of patients undergoing previous therapy was highest in the first 10 patients (70%) compared with subsequent patients (39%). Continue reading

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? RESULTS (Part 2)

Survey of gastroenterologists
A total of 147 gastroenterologists were listed in the Quebec College des Medecins directory. Response rate after the second mailing was 41% (60 of 147). Although 90% of respondents agreed that surgical myotomy represented the most effective long-termtreatment for achalasia (Figure 3A), only 37% would refer a newly diagnosed patient for immediate Heller myotomy (Figure 3B).

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Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? RESULTS (Part 1)

Heller myotomy Local treatment patterns A total of 38 patients underwent laparoscopic Heller myotomy at the Montreal General Hospital, Montreal, Quebec from June 1999 to April 2004. Overall, 47% (18 of 38) of the patients had one or more endoscopic interventional procedures before referral for laparoscopic myotomy. Botulinum toxin injection alone was used in six patients, 10 had pneumatic dilation alone and two had both. The proportion of patients having endoscopictreatment before surgery declined from 70% in the first 10 patients (seven of 10) to 39% (11 of 28) subsequently (P=0.19). buy asthma inhalers

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Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? Methods (Part 2)

To assess the referring physicians’ biases in the treatmentof achalasia, a six-question survey (Figure 1) exploring the management of achalasia was sent to all gastroenterologists listed in the 2002 Quebec specialist medical directory. Questionnaires were mailed in both English and French. Nonresponse prompted the mailing of a second questionnaire after six weeks. Continue reading

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? Methods (Part 1)

Local patterns of treatmentfor achalasia were assessed by reviewing prospectively collected data on all patients undergoing laparoscopic Heller myotomy at the McGill University Health Centre, Montreal, Quebec. The numbers and types of endoscopic intervention before surgery were recorded and compared between years. All laparoscopic Heller myotomies included a partial anterior 180° fundoplication and were performed or supervised by a single surgeon (GMF). asthma inhalers Continue reading

Has the introduction of laparoscopic Heller myotomy altered the treatment paradigm of achalasia? (1)

Achalasia

Achalasia is a rare esophageal motility disorder characterized by uncoordinated contractions of the esophagus leading to ineffective swallowing. Relief of dysphagia represents the primary treatment goal for patients with achalasia. Medical, endoscopic and surgical treatments have all been employed, with varying success rates. Despite minimal risk, pharmacological calcium channel blockade has generally not been effective for relief of dysphagia . Widely used endoscopic treatment options include Botulinum toxin injection and pneumatic dilation. While initial response rates for intramuscular Botulinum toxin are as high as 70%, the response is short lived, with a recurrence rate approaching 90% at six months . Long-term results of endoscopic disruption of the muscularis layer by pneumatic dilation are also suboptimal, with permanent success in only 40% to 50% of patients . Due to the intramural inflammation and scarring resulting from endoscopic therapies, the risk for mucosal injury is potentially increased if a subsequent myotomy is performed . You can finally spend less time to discover always paying lower prices.
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