Comparison of medical and minimally invasive surgical therapy for primary esophageal motility disorders.

OBJECTIVE: To compare medical with minimally invasive surgical therapy in the treatment of primary esophageal motility disorders.

DESIGN: Prospective study.

SETTING: University-based tertiary care center.

PATIENTS: Eighty-nine patients (46 men and 43 women) with either achalasia or nutcracker esophagus and diffuse esophageal spasm (DES). Choice of treatment was based not on randomization but on the preference of the referring physician, the patient's choice, and/or the patient's eligibility to access the University of California, San Francisco, for treatment.

INTERVENTIONS: Nineteen patients with achalasia and 30 patients with nutcracker esophagus and DES were treated with dilatations and/or medications. Thirty patients with achalasia and 10 with nutcracker esophagus and DES underwent a thoracoscopic myotomy.

MAIN OUTCOME MEASURES: Dysphagia, pain, and overall quality of life.

RESULTS: In the surgical group, 80% of the patients with nutcracker esophagus and DES and 87% of the patients with achalasia had good or excellent results. In contrast, in the medical group, 26% of the patients with nutcracker esophagus and DES and 26% of the patients with achalasia had good or excellent results.

CONCLUSIONS: Surgery by minimally invasive techniques offers a better chance than does medical therapy or dilatation of rendering the patient with achalasia, nutcracker esophagus, and DES asymptomatic.