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De Aquino et al. Esophageal mucosectomy in advanced achalasia

Esophagogastrostomy leak was found in this technique Functional asocial parameters had satisfactory
in a rate similar to other series [14,21,23] . Leakage seems outcomes as shown by weight gain, quality of life,
not be linked to the resection procedure but to other satisfaction and return to work.
topics such as absence of serosa in the esophagus,
deficient vascularization, constant movement In conclusion, esophageal mucosectomy and
with swallow, and low nutrition status of some endomuscular pull-through seems to be a valuable
patients [2,13,21,24] . alternative to esophagectomy in patients with end-
stage achalasia.
The risk for bleeding in the muscular tunnel is small.
All patients had hemodynamic stability after the DECLARATIONS
procedure and only few required transfusion. Parrilla
[7]
Paricio et al. showed in his series no more than Authors’ contributions
100 mL of blood collected after external drainage Conceived and designed the study, wrote and
of the muscular tunnel in 3 patients that underwent reviewed the manuscript: J.L.B. De Aquino
mucosectomy due to cardia cancer. Other series; Collected and tabulated data, participated in
however, showed a higher level of bleeding (700- manuscript writing: M.M. Said
800 mL) but without hemodynamic instability Participated in manuscript writing and review: J.G.T.
nonetheless [8,25] . Aquino et al. [18] showed - in an De Camargo
experimental study in dogs - absence of active
bleeding 2 h after mucosectomy. Spontaneous Financial support and sponsorship
hemostasis occurs due to anatomic characteristics of None.
the vessels that branches in the submucosa [26] .
Conflicts of interest
Early results for mucosectomy are very acceptable. There are no conflicts of interest.
Only 12% of the patients had intraoperative
complications and in a significantly lower rate Patient consent
compared to transhiatal esophagectomy in the own The patient consent was obtained.
author’s experience (69%). Early postoperative
complications were also lower for mucosectomy Ethics approval
compared to transhiatal esophagectomy [19] . This study was approval by the local Research Ethics
Committee.
Long-term follow-up (between 10-15 years) in 42
patients showed excellent and good results in over REFERENCES
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