30 year follow up study

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I found this article in Pub Med... Interesting. There are about 5-10 new articles about achalasia each month, surprising, isn't it? Okay some are from countries that don't have an image of medical leaders and to me, they seem about 5 years behind. But still very interesting. This one goes back 30 years.

Ann Surg. 2006 Feb;243(2):196-203.

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Very Late Results of Esophagomyotomy for Patients With Achalasia: Clinical, Endoscopic, Histologic, Manometric, and Acid Reflux Studies in 67 Patients for a Mean Follow-up of 190 Months.Csendes A, Braghetto I, Burdiles P, Korn O, Csendes P, Henriquez A.From the Department of Surgery, University Hospital, Santiago, Chile.INTRODUCTION:: Laparoscopic esophagomyotomy is the preferred approach to patients with achalasia of the esophagus, However, there are very few long-term follow-up studies (>10 years) in these patients. OBJECTIVE:: To perform a very late subjective and objective follow-up in a group of 67 patients submitted to esophagomyotomy plus a partial antireflux surgery (Dor's technique). MATERIAL AND METHODS:: In a prospective study that lasted 30 years, 67 patients submitted to surgery were divided into 3 groups: group I followed for 80 to 119 months (15 patients); group II, with follow-up of 120 to 239 months (35 patients); and group III, with follow-up more than 240 months (17 patients). They were submitted to clinical questionnaire, endoscopic evaluation, histologic analysis, radiologic studies, manometric determinations, and 24-hour pH studies late after surgery. RESULTS:: Three patients developed a squamous cell esophageal carcinoma 5, 7, and 15 years after surgery. At the late follow-up, Visick III and IV were seen in 7%, 23%, and 35%, according to the length of follow-up of each group. Endoscopic examination revealed a progressive nonsignificant deterioration of esophageal mucosa, histologic analysis distal to squamous-columnar junction showed a significant decrease of fundic mucosa in patients of group III, with increase of intestinal metaplasia, although not significant time. Lower esophageal sphincter showed a significant decrease of resting pressure 1 year after surgery, which remained similar at the late control. There was no return to peristaltic activity. Acid reflux measured by 24-hour pH studies revealed a progressive increase, and the follow-up was longer. Nine patients developed Barrett esophagus: 6 of them a short-segment and 3 a long-segment Barrett esophagus. Final clinical results in all 67 patients demonstrated excellent or good results in 73% of the cases, development of epidermoid carcinoma in 4.5%, and failures in 22.4% of the patients, mainly due to reflux esophagitis. Incomplete myotomy was seen in only 1 case. CONCLUSION:: In patients with achalasia submitted to esophagomyotomy and Dor's antireflux procedure, there is a progressive clinical deterioration of initially good results if a very long follow-up is performed (23 years after surgery), mainly due to an increase in pathologic acid reflux disease and the development of short- or long-segment Barrett esophagus.PMID: 16432352 [PubMed - in process]