A Prospective Study on Manometric Evaluation of Achalasia Cardia Following Heller???s Cardiomyotomy

Author(s):

Vivek Srivastava*, Rajendra Prasad, Mumtaz Ansari and V K Dixit

Introduction: Achalasia cardia is the most commonly diagnosed primary esophageal motor disorder. High-Resolution Manometry (HRM) is highly sensitive modality of diagnosis. Laparoscopic Heller’s Myotomy (LHM) is the main modality to treat Achalasia.

Aim: To compare pre and post treatment manometric variables among the achalasia cardia subtypes based on HRM at 3, 6 and 12 months of followup.

Results: A total 30 patients of achalasia cardia underwent LHM with a mean of 36.76 ± 8.42 years (range 21-56 years) with 7, 18 and 5 patients belonged to type I, type II and type III Achalasia respectively. During followup 4 patients (13.3%) developed recurrence of symptoms. One patient of type II developed recurrence at 3 months of followup and was managed with pneumatic dilatation who did well after the endoscopic procedure while 2 patients of type III developed recurrence at 3 months. The height and width of the barium column in timed barium esophagogram, among the three subtypes were comparable in all three types at both 1 min and 5 min. After 3, 6 and 12 months of treatment Eckardt symptom scores improved and was comparable in all the achalasia sub-types. On comparing the LESP, IRP and DCI as assessed by HRM the mean value of LESP was higher in type III achalasia as compared to type I and II but not statistically significant. IRP and DCI values were also comparable in all types of achalasia. After 3, 6 and 12 months, the LESP, IRP were comparable in all subtypes of achalasia.

Conclusion: Success rates in type I and II are higher than type III. The recurrence following LHM can be successfully managed with pneumatic dilation.