Is the failure of the LES to relax, or the presence of secondary peristaltic waves, indicative of a poor prognosis after surgery ?
H.J. Stein. T.R. DeMeester (Omaha)
The presence of a failure of the lower esophageal sphincter to relax and the presence of secondary peristaltic waves have been suggested as indicators of a poor prognosis after surgery for diffuse esophageal spasm. In our experience, these factors do not correlate with the success of myotomy of the esophageal body and the lower esophageal sphincter. Rather, success of myotomy appears to be related to an accurate documentation of primary diffuse esophageal spasm as the cause of the symptoms, and manometric evaluation of the extent of esophageal involvement in the disease.
A myotomy performed through all muscle layers, extending distally over the stomach 1-2 cm below the gastroesophageal junction and proximal on the esophagus over the distance of the manometric abnormality, will improve forward movement of food from the mouth to the stomach by decreasing sphincter resistance and reducing the amplitude of abnormal esophageal contractions independent of other preoperative manometric findings.