Laparoscopic Heller Myotomy for Type II Achalasia

Oscar M. Crespin, MD; Brant K. Oelschlager, MD; Carlos A. Pellegrini, MD


March 26, 2013

Manometry Patterns in Achalasia

Type I Achalasia

Figure 4 is consistent with the pattern of type I achalasia. There is almost no pressurization in the proximal, middle, or distal portion of the esophagus with each swallow.

Figure 5 permits comparison between a normal swallow and type I achalasia. The color topography (indicated by black arrows) is light blue, showing a lack of pressure (represented in the pressure scale) from the upper esophageal sphincter to the LES.

Figure 5a. Normal swallow. 5b. Type I achalasia.

Type II and Type III Achalasia

Although all 3 types of achalasia involve absence of peristalsis and impaired relaxation of the LES, the compression of type II would be represented graphically in yellow, showing compartmentalized pressurization spanning the entire length of the esophagus but without the necessary pressure to elicit a swallow and probably indicating early-stage achalasia. The manometric spastic characteristic of achalasia type III would appear as high-amplitude pressurization represented in red, attributable to an abnormal lumen-obliterating contraction (Figure 6).

Figure 6a.Type II achalasia. 6b. Type III achalasia.

Figure 4. Manometric pattern for the next question, below.

Figure 7. Please review these upper gastrointestinal series images for the next question, below.