When is myotomy indicated for the surgical treatment of esophageal spasm?

Updated: Aug 07, 2019
  • Author: Ahmad Malas, MD; Chief Editor: BS Anand, MD  more...
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Answer

Myotomy is effective for treating diffuse esophageal spasm. [26] The myotomy should extend the entire length of the involved segment, which should be determined preoperatively with manometry. Furthermore, the myotomy should extend through the lower esophageal sphincter (LES) to help prevent dysphagia postoperatively by preventing outlet obstruction. Finally, an antireflux procedure should be performed concomitantly, by either a partial wrap or a Nissen fundoplication.

Myotomy should be used with caution in patients with nutcracker esophagus because it may worsen the symptoms. Myotomy reduces the amplitude of the contractions, but this does not consistently improve symptoms, especially if the primary complaint is pain. Furthermore, dysphagia can develop or worsen after myotomy because the effectiveness of the propagative waves is eliminated, leaving gravity to propel food caudally.


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