Leconte M et al. (2007) Functional results after extended myotomy for diffuse oesophageal spasm. Br J Surg 94: 1113–1118

Researchers from France have shown that extended myotomy with anterior fundoplication achieved excellent medium-term functional results in a series of patients with severe diffuse esophageal spasm (DES).

There is controversy surrounding the appropriate treatment of DES. Patients who do not respond to endoscopic treatment are sometimes offered surgical management, but few studies have evaluated the efficacy of this approach. In this prospective study, Leconte and colleagues assessed functional outcomes in 20 patients suffering from severe DES who underwent surgery.

The surgical procedure involved extended, modified Heller myotomy with muscular crural closure and anterior fundoplication via a laparotomy. The myotomy extended 12–16 cm above the cardia, and 2 cm below the esophagogastric junction. Outcomes were assessed using dysphagia, chest pain and overall clinical scores.

After a median follow-up of 50 months (range 6–84 months), the results showed that all clinical outcomes were significantly improved compared with preoperative scores (P <0.01). Excellent or satisfactory results were observed for overall clinical score, dysphagia score and chest pain score in 16, 18, and 20 patients, respectively. Two patients were found to have gastroesophageal reflux postoperatively.

The authors comment that, although their results are encouraging, it is possible that they were biased by certain features of the study design, such as the use of scoring systems based on symptom frequency rather than intensity. Further studies in larger patient populations and with longer follow-up are required to confirm the promising findings reported in this study.