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By T. Wehrmann (auth.), Prof. Dr. Dr. E. Hanisch, Prof. Dr. M. Kitajima, PD Dr. T. Wehrmann, Prof. Dr. A. Encke (eds.)

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Extra resources for Endoscopic Gastric Surgery

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IMln 0 1 2 Fig. S. Esophageal manometry in health (left) and achalasia (right) tion of an esophageal syndrome similar to achalasia. The so-called Chagas' disease is endemic in South America (particularly in Brazil). Unlike achalasia, clinical involvement of the small intestine and the colon, as well as the heart and urinary tract, is common in patients with Chagas' disease. Very seldom, amyloidosis of the esophagus produces an achalasia-like picture (aperistalsis and impairment of LES relaxation).

1994; Parrilla et al. 1992; Pricolo et al. 1993). Results of cardiomyotomy are not influenced by previous dilatation. There is only one study group which prospectively compared the results of pneumatic dilatation and that of operative cardiomyotomy (Csendes et al. 1991). The authors found that surgery gave better long-term improvement than forceful dilatation. Because the efficacy of pneumatic dilatation in these series seemed less than in other trials, this conclusion has been questioned. Botulinum Toxin Injection Botulinum toxin A is a neurotoxin from Clostridium botulinum that inhibits the release of acetylcholine from cholinergic nerve endings (Schiano et al.

1999), have shown that about 70% of achalasia patients could be satisfactorily managed by repeated (median, three) BTX injections during long-term follow-up (1-4 years). Up to now, it is not well defined which achalasia patients are the best candidates for BTX treatment. In our opinion, these are patients with local (tortuous megaesophagus and/or epiphrenic diverticulum) or systemic (advanced age and/or serious co-morbidity) risk factors, rendering dilatation and cardiomyotomy very risky. It may also be an alternative for patients wishing to delay definite therapy.

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