Delayed Surgical Management of Achalasia Leads to Patient Physical Decline
Abstracts
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BACKGROUND: Laparoscopic Heller myotomy has emerged as the definitive treatment modality for achalasia providing excellent symptomatic relief of dysphagia. However, delay in recognition and workup of achalasia is still common. This study assesses the frequency and implications of delay in surgical referral. METHOD: In 9 yrs, 125 patients without previous esophageal surgery were referred for operative management of achalasia. Patient records were reviewed for symptom duration, weight changes, and number of nonsurgical (BoTox/Dilation) interventions used prior to surgical referral. Standard symptom scores for reflux and dysphagia were recorded prior to surgery and at follow-up. Data were analyzed using regression analysis and values are reported as mean?SEM. RESULTS: Laparoscopic Heller myotomy significantly improved patient dysphagia symptoms in 119 of 125 patients (95%). Patients reported symptoms of 57?6 months duration prior to surgery (p<0.001). While the mean age of these patients is 47?2, there was a trend towards greater weight loss in the older population (r=0.2, p=0.01). Older patients received more nonsurgical interventions prior to seeking surgery (r=0.3, p=0.01). Patients undergoing more nonsurgical interventions for symptom relief were more likely to have greater preoperative weight loss (r=0.6, p<0.001, see figure). CONCLUSIONS: Despite excellent results for surgical treatment of achalasia, there is significant time lapse between symptom onset and surgical attention. Delay in definitive treatment, particularly in the older patient, may be associated with physical decline. These observations further amplify the need for earlier surgical referral. |
