Resection of the lower esophageal sphincter to treat achalasia

Information was given by Dr. Do Minh Hung, Director of the Center for Gastrointestinal Endoscopy and Endoscopic Surgery, Tam Anh General Hospital, Ho Chi Minh City, at the Conference “Upper gastrointestinal motility disorders: We Where are you?” organized by Tam Anh Hospital in collaboration with Tam Anh Research Institute on October 26.

Cardiac spasm occurs when the esophagus cannot push food down to the stomach due to abnormal motility of the esophageal body, the lower esophageal sphincter does not open completely, causing food to stagnate in the esophagus. This is a chronic disease that requires long-term monitoring and in-depth evaluation.

Treatment for achalasia focuses on widening the lower esophageal sphincter so that food and liquid can move from the esophagus to the stomach more easily. Specific treatment depends on your health condition, age, severity and type of disease (type 1, 2 or 3). The goal is to resolve symptoms of choking, chest pain… and preserve esophageal function for the patient.

To cut the lower esophageal sphincter through the mouth (Peroral Endoscopic Myotomy – POEM), the endoscoper creates a submucosal tunnel in the esophagus and the first part of the stomach, thereby cutting the lower esophageal muscle and 2 cm of the lower esophagus. on the stomach. To limit reflux after POEM surgery, the surgery avoids cutting too long or too much towards the stomach, combining POEM with creating an anti-reflux valve…

Dr. Pham Huu Tung, Deputy Director of the Center for Gastrointestinal Endoscopy and Endoscopic Surgery, Tam Anh General Hospital, Ho Chi Minh City, said that POEM is less invasive, leaves no scars, and has been performed in many countries around the world. In Vietnam, a number of hospitals have applied it, including the Tam Anh General Hospital system. After treating achalasia with POEM at Tam Anh hospital, the results showed a high cure rate, nearly 95%, with long-term effectiveness.

In addition to POEM, doctors may prescribe treatment for achalasia that also includes medical treatment with medication, endoscopic treatment with injection of botulinum toxin into the lower esophageal sphincter, oral medication, balloon dilation of the esophageal sphincter, Heller transabdominal laparoscopic surgery, esophagectomy.

According to Dr. Tung, taking medicine is not very effective, there is a risk of drug resistance and side effects. Balloon angioplasty has a high recurrence rate, about 60% relapse after one year and must be performed multiple times. Heller surgery has a success rate of 90% after two years of follow-up, but complications of mucosal tearing during myotomy are about 12%.

Cardiac spasm is a benign disease. However, if not accurately identified and treated effectively, it can lead to complications of malnutrition due to the patient choking and being unable to eat or drink, aspiration pneumonia due to vomiting, and cancer of the chronically inflamed area.

Symptoms of the disease often include choking on solid and liquid foods, vomiting, choking on food, prolonged cough, hoarseness, wheezing, pneumonia, heartburn, chest pain, and weight loss. The disease often occurs in middle age. The exact cause of difficulty swallowing is unknown. Some hypotheses about the cause have been proposed such as loss of nerve cells in the esophagus, viral infection or autoimmune reaction due to genetic disorders or infections but these are rare.

Currently, high-resolution esophageal manometry (HRM) is the “gold” standard to help diagnose movement disorders in the esophageal body and the esophageal-gastric junction. Other methods include investigating the function of the esophagus, X-ray of the esophagus with contrast medium, esophagogastroduodenoscopy, computed tomography (CT) or endoscopic ultrasound (EUS). .