Minimally invasive management in end-stage achalasia

Abstract

Background: End-stage achalasia is characterized by severe dilation and tortuosity of the esophagus and the clinical presentation includes dysphagia and progressive malnutrition.
Objective: The aim of this presentation is to present a case series of megaesophagus due to end-stage achalasia that was managed with surgery.
Material and methods: We conducted an observational, retrospective and descriptive study. All the patients with end-stage achalasia operated on using a minimally invasive approach between March 2008 and October 2023 were included in the study.
Results: In the study period, 8 patients (mean age 56 ±11.2 years; 5 were female) were treated with minimally invasive techniques for end-stage megaesophagus due to achalasia. One case corresponded to megaesophagus due to Chagas disease and the other 7 were due to recurrence of symptoms after a Heller-Dor myotomy that had been managed with endoscopic dilatations. The following techniques were used: 5 cardioplasty procedures, 1 laparoscopic transhiatal esophagectomy, 1 minimally invasive esophagectomy in prone position and 1 resection of the esophagogastric junction and Roux-en-Y bypass.
Conclusion: In the series presented here, minimally invasive cardioplasty was the most used technique for the treatment of end-stage achalasia, with a low percentage of complications. Other techniques were also used for other selected cases based on a multidisciplinary approach.