Related Experiment Video

Updated: Jul 9, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
09:40

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

A comprehensive appraisal of the surgical treatment of diffuse esophageal spasm

Cristina Almansa1, Ronald A Hinder, C Daniel Smith

  • 1Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|December 12, 2007
PubMed

Insights

Surgical intervention for diffuse esophageal spasm (DES) involves esophageal myotomy, similar to achalasia treatment. This review appraises surgical outcomes and complications for this poorly understood motility disorder.

Area of Science:

  • Gastroenterology
  • Surgical Gastroenterology

Background:

  • Diffuse esophageal spasm (DES) is a poorly understood esophageal motility disorder.
  • Optimal treatment strategies for DES remain controversial due to a lack of evidence-based data.
  • Medical therapies for DES have limited efficacy, prompting consideration of surgical options for refractory cases.

Purpose of the Study:

  • To review the current literature on the surgical management of diffuse esophageal spasm.
  • To evaluate surgical outcomes, including effects on manometric and radiologic parameters.
  • To assess complications and mortality associated with surgical treatment for DES.

Main Methods:

  • Literature review of available studies on surgical management of diffuse esophageal spasm.
  • Appraisal of reported surgical outcomes and complications.
  • Analysis of manometric and radiologic data where available.

Main Results:

  • Surgical treatment for DES typically involves a long esophageal myotomy, analogous to achalasia surgery.
  • Antireflux procedures may be incorporated to mitigate postoperative gastroesophageal reflux.
  • Evidence from randomized clinical trials on surgical treatment for DES is currently lacking.

Conclusions:

  • Surgical myotomy is a potential treatment for refractory diffuse esophageal spasm.
  • Further research, including randomized clinical trials, is needed to establish evidence-based guidelines for surgical management.
  • Careful patient selection and surgical technique are crucial for optimizing outcomes and minimizing complications.

Related Concept Videos

Esophageal Strictures-II: Clinical Features and Management01:26

Esophageal Strictures-II: Clinical Features and Management

Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...
Gastroesophageal Reflux Disease II: Clinical Features and Management01:29

Gastroesophageal Reflux Disease II: Clinical Features and Management

Gastroesophageal reflux disease, or GERD, is a persistent medical condition that affects many individuals worldwide. Its clinical manifestations can vary greatly, making diagnosis and management challenging for healthcare professionals. The following is a comprehensive overview of the clinical manifestations, assessment, and management strategies for GERD.
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
Esophageal Varices-II: Clinical Features and Management01:28

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol abuse, or...
Esophageal Perforation-II: Clinical Manifestations and Management01:28

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:
Barrett Esophagus-II: Clinical Manifestations and Management01:21

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure entails...
Esophageal Varices-I: Introduction01:24

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...