James wrote:

> Anyone know of any studies which discuss long-term (20 year) success rates as
well as the rate of eventual ectomy?
>
> I have seen number that state around 7-10% eventually need an ectomy but I was
not confident in the numbers.

I have a collection of bibliographic entries, mostly from PubMed, about
achalasia at the Achalasia Atheneum. One of the collections in it is for
long-term studies for myotomy.

http://www.zotero.org/groups/achalasia_atheneum/items/collection/2179157

Zotero seems to have a problem with large collections, which the
Achalasia Atheneum is. You may get the message, "error fetching groups"
If you do, try again and try later. The best way to use it if you think
your would use it much is to install the add-on for FireFox and join the
Achalasia Atheneum group and have it sync to your groups. That way you
don't get the error and you can even use the data offline. The add-on
also gives you a search feature. If you use it with the Achalasia
Atheneum you will be searching entries (with abstracts and more) for
only achalasia related sources.

In the long-term myotomy collection loads correctly there should be 21
entries. Keep in mind that minimally invasive surgeries for achalasia
are only about twenty years old. To go back that far studies often
include results from conventional, open surgery. Also remember that
there is a learning curve with the techniques, not just for a surgeon
but also for the development and comparison of techniques. The studies
that cover the most years for the minimal techniques go back to a time
when everyone was new at it. Over time techniques and result rates
become better. You will notice some studies are of techniques we don't
hear much of anymore, like Belsey fundoplication. Also note that null
results are often not listed. A study that had zero esophagectomies may
not have reported that. Here are some highlights from the collection.

2008 Very long-term objective evaluation of heller myotomy
plus posterior partial fundoplication in patients with achalasia of the
cardia
http://www.ncbi.nlm.nih.gov/pubmed/18216530
"...a prospective study of 149 patients...The median follow-up was 6
years (range, 1-27 years). Follow-up period was over 10 years in 53
patients and over 15 in 36. ... Both esophagitis and pathologic rates of
reflux appeared in >40% of the patients late in the follow-up."

1994 Long-term results in surgically managed esophageal achalasia
http://www.ncbi.nlm.nih.gov/pubmed/7979656
"...(n = 22) are those patients whose first procedure (myotomy and
Belsey partial fundoplication) ... A good to excellent results occurred
in 21/22 patients (95%) at 1 year, 17/22 (77%) at 5 years, 15/22 (68%)
at 10 years, 11/16 (69%) at 15 years, and 6/9 (67%) at 20 or more years.
... Three patients underwent esophagectomy (7, 19, and 23 years) and one
patient underwent an antrectomy and Roux-en-Y diversion (23 years)."

2010 Functional analysis of long-term outcome after Heller's myotomy for
achalasia.
http://www.ncbi.nlm.nih.gov/pubmed/20002701
"One-year, 2-year, 5-year, 10-year, and 20-year postoperative follow-up
information was available in 100% of all patients, 91.7%, 85.1%, 60%,
52.6%, and 45.9%,... "

2002 Long-term effects of myotomy and partial fundoplication for
esophageal achalasia.
http://www.ncbi.nlm.nih.gov/pubmed/12220428
"...32 patients... partial fundoplication (Belsey Mark IV)...
Preoperative assessment was compared with that in 0-3, 3-7, and 7-16
postoperative years. Clinically, the prevalence of dysphagia was
decreased from 100% to 6%, 12%, and 13%, respectively."

2006 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.
http://www.ncbi.nlm.nih.gov/pubmed/16432352
"...prospective study that lasted 30 years. 67 patients... Three
patients developed a squamous cell esophageal carcinoma 5, 7, and 15
years after surgery. ... Nine patients developed Barrett esophagus...
failures in 22.4% of the patients, mainly due to reflux esophagitis."


2006 Long-term results after Heller–Dor operation for oesophageal achalasia
http://ejcts.ctsnetjournals.org/cgi/content/full/29/6/914
"173 were followed-up (mean 109 months, range 12–288, median 93 months)
of whom 68 for more than 15 years. ... Seven out of 173 patients (4%), 6
of whom were pre-operatively classified as sigmoid achalasia,
subsequently underwent oesophagectomy, 3 for epidermoid cancer, 1 for
Barrett's adenocarcinoma, 2 for stasis oesophagitis and recurrent
sepsis, 1 for severe dysphagia."

2006 Long-term results of conventional myotomy in patients with
achalasia: a prospective 20-year analysis.
http://www.ncbi.nlm.nih.gov/pubmed/17175461
"...20-year analysis of the conventional cardiomyotomy... follow-up was
55 (range, 6-206) months."

2005 The incidence of gastroesophageal reflux after transthoracic
esophagocardio-myotomy without fundoplication: a long term follow-up.
http://www.ncbi.nlm.nih.gov/pubmed/15740938
"...follow-up after surgery was 10.3 years, ranging from 3-16 years.
...pH-metry showed moderate reflux in 46%."

Related to this collection is the collection, Failure and Predictors of
Outcome.
http://www.zotero.org/groups/achalasia_atheneum/items/collection/2179041

notan