Abstracts
2002 Digestive Disease Week

# 106718 Abstract ID: 106718 Preoperative Intervention Does Not Affect Esophageal Muscle Histology or Postoperative Outcomes in Patients Undergoing Laparoscopic Heller Myotomy
Mark Bloomston, Magda Banasiak, E Zervos, Amerigo Gonzalvo, Alexander S Rosemurgy II, Tampa, FL

Background: Botox injection and pneumatic dilation are common therapies for achalasia. Little is known regarding their impact on esophageal muscle and subsequent myotomy, as well as outcome. We sought to determine the impact of these preoperative therapies on esophageal muscle histology and outcomes following laparoscopic Heller myotomy. Methods: 170 patients with achalasia have undergone laparoscopic Heller myotomy with intraoperative endoscopy at our institution. 73 consecutive patients had esophageal muscle biopsies taken from the gastroesophageal junction at the time of myotomy between November 1998 and November 2001. Muscle biopsies were stained with H&E and Masson stains and fibrosis graded by a senior pathologist blinded to preoperative treatments and postoperative outcomes: scale 0 (no fibrosis) to 5 (100% fibrosis). Patients graded dysphagia and heartburn using a Likert scale before and after myotomy and graded their outcomes at follow-up. All patients are being followed at median 16 months after myotomy. Data are mean ? SD, when appropriate. Results: There were no intergroup differences in preoperative or postoperative dysphagia and heartburn scores (table). Dysphagia significantly improved in all groups and there was a trend toward improved heartburn scores. Excellent/good outcomes were obtained in 93% of patients overall. Conclusions: Successful outcomes are highly probable following laparoscopic Heller myotomy regardless of preoperative interventions. Outcomes are not notably impacted by either therapy. The amount of fibrosis in the esophageal muscle is not related to preoperative intervention and does not affect outcomes.