ArticleThe Journal of thoracic and cardiovascular surgery2025
Heller myotomy for esophageal achalasia: Outcomes in 1010 patients with longitudinal follow-up.
Article in The Journal of thoracic and cardiovascular surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Heller myotomy in achalasia: clinical implications from long-term outcomes.Journal of thoracic disease · 2026Article
- Modern treatment for achalasia: endoscopic and surgical therapies.The British journal of surgery · 2026Review
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13 authors.
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Abstract
backgroundAchalasia is a rare progressive disease for which longitudinal outcomes and optimal follow-up remain poorly defined. We assessed longitudinal reintervention, symptom palliation, and esophageal emptying after Heller myotomy performed in more than 1000 patients over a 25-year period.
methodsBetween January 1, 1995, and January 1, 2020, a total of 1010 adults underwent Heller myotomy at Cleveland Clinic. The operation was minimally invasive in 937 (93%) patients, with Dor fundoplication in 838 (92%). Esophageal emptying was assessed by timed barium esophagram (TBE), and symptoms were quantified by Eckardt score. Multiphase mixed-effects models and Kaplan-Meier analysis were used to estimate longitudinal symptom palliation, esophageal emptying, and reintervention (pneumatic dilation ≥30 mm, per-oral endoscopic myotomy, repeat Heller myotomy, or esophagectomy).
resultsFreedom from any reintervention was 75% and freedom from esophagectomy was 96.8% at 10 years postmyotomy. The risk of reintervention was greatest during the first year, with 1 reintervention portending additional reintervention(s). Severe recurrent symptoms were rare, with a probability of freedom from severe dysphagia (daily or every meal) of 74% and probability of an Eckardt score ≤3 of 68% at 10 years. The probability of complete TBE emptying was 55% immediately postmyotomy and decreased to 24% by 10 years.
conclusionsHeller myotomy provides long-term symptom palliation and esophageal emptying for patients with achalasia, with a gradually increasing risk of reinterventions over time, highlighting the importance of initial annual follow-up. After 3 years, the follow-up interval may be increased to every 3 years when symptom relief and esophageal emptying remain stable. These findings provide a long-term benchmark for future therapies.
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