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Invited Critique
February 2013

Partial Recovery of Peristalsis After Myotomy for Achalasia: Rethinking the RuleComment on “Partial Recovery of Peristalsis After Myotomy for Achalasia”

Author Affiliations

Author Affiliations: Medstar Union Memorial Hospital, Baltimore, Maryland.

JAMA Surg. 2013;148(2):164. doi:10.1001/2013.jamasurg.45

In this study,1 30 patients with achalasia underwent evaluation with high-resolution manometry and esophageal pressure topography before and after myotomy. Myotomies were laparoscopic, open, or peroral endoscopic procedures in 24, 1, and 5 patients, respectively. Before treatment, patients were classified into 3 groups according to the Chicago classification. Type 1 elicited no peristalsis or pressurization (8 [27%]), type 2 elicited panesophageal pressurization only (17 [57%]), and type 3 showed premature contractions (5 [17%]). Only type 3 patients demonstrated peristalsis before treatment; however, after myotomy, peristaltic activity was noted in 63%, 47%, and 80% of types 1, 2, and 3 patients, respectively.

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