Treatment of achalasia: lessons learned with Chagas' disease

Treatment of achalasia: lessons learned with Chagas' disease

Chagas’ disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia...

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Bibliographic Details
Published in:Diseases of the esophagus Vol. 21; no. 5; pp. 461 - 467
Main Authors: Herbella, F. A. M., Aquino, J. L. B., Stefani-Nakano, S., Artifon, E. L. A., Sakai, P., Crema, E., Andreollo, N. A., Lopes, L. R., De Castro Pochini, C., Corsi, P. R., Gagliardi, D., Del Grande, J. C.
Format: Journal Article
Language:English
Published: Malden, USA Blackwell Publishing Inc 01-08-2008
Subjects:
achalasia
Brazil
Catheterization - methods
Chagas Disease - mortality
Chagas Disease - surgery
Chagas Disease - therapy
Chagas' disease
Esophageal Achalasia - mortality
Esophageal Achalasia - surgery
Esophageal Achalasia - therapy
Esophagectomy - methods
Esophagoplasty - methods
Esophagoscopy - methods
esophagus
Esophagus - pathology
Esophagus - surgery
Female
Humans
Injections, Intralesional
Male
Minimally Invasive Surgical Procedures - methods
Neuromuscular Agents - therapeutic use
Prognosis
Risk Assessment
Severity of Illness Index
surgery
Survival Analysis
Treatment Outcome
Brazil
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Summary:Chagas’ disease (CD) is highly prevalent in South America. Brazilian surgeons and gastroenterologists gained valuable experience in the treatment of CD esophagopathy (chagasic achalasia) due to the high number of cases treated. The authors reviewed the lessons learned with the treatment of achalasia by different centers experienced in the treatment of Chagas’ disease. Preoperative evaluation, endoscopic treatment (forceful dilatation and botulinum toxin injection), Heller's myotomy, esophagectomy, conservative techniques other than myotomy, and reoperations are discussed in the light of personal experiences and review of International and Brazilian literature. Aspects not frequently adopted by North American and European surgeons are emphasized. The review shows that nonadvanced achalasia is frequently treated by Heller's myotomy. Endoscopic treatment is reserved to limited cases. Treatment for end‐stage achalasia is not unanimous. Esophagectomy was a popular treatment in advanced disease; however, the morbidity/mortality associated to the procedure made some authors seek different alternatives, such as Heller's myotomy and cardioplasties. Minimally invasive approach to esophageal resection may change this concept, although few centers perform the procedure routinely.
Bibliography:ArticleID:DOTE811
ark:/67375/WNG-7W94T4CR-0
istex:CBB37D2AFE4A13BAFF358ED58BA2C93D3C5ACA22
Author's contribution: FAH: conception and design, writing of the final version of the manuscript. All authors: data collection, writing parts of the manuscript, approval of the final version of the manuscript.
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ISSN:1120-8694
1442-2050
DOI:10.1111/j.1442-2050.2008.00811.x